Provider Demographics
NPI:1841655032
Name:WETHINGTON, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WETHINGTON
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 1:29117 HIDDEN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-1246
Mailing Address - Country:US
Mailing Address - Phone:734-299-1320
Mailing Address - Fax:
Practice Address - Street 1:29117 HIDDEN RIVER DR
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48173-1246
Practice Address - Country:US
Practice Address - Phone:734-299-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703111533164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse