Provider Demographics
NPI:1134968555
Name:WERDEL, CARLY INEZ
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:INEZ
Last Name:WERDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 NW FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5166
Mailing Address - Country:US
Mailing Address - Phone:208-954-0848
Mailing Address - Fax:
Practice Address - Street 1:520 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6411
Practice Address - Country:US
Practice Address - Phone:208-954-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR110828175T00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No175T00000XOther Service ProvidersPeer Specialist