Provider Demographics
NPI:1952702375
Name:WORNUM, CASEY (LPN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:WORNUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3804
Mailing Address - Country:US
Mailing Address - Phone:617-633-6464
Mailing Address - Fax:
Practice Address - Street 1:12 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3804
Practice Address - Country:US
Practice Address - Phone:617-633-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN87363164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse