Individual
CARLY WORDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2707 15TH PL, KENOSHA, WI 53140-4947
(262) 551-2700
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(262) 551-2700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10299-33
WI
363LF0000X
Family Nurse Practitioner
10299-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100104069
—
WI
Enumeration date
09/09/2020
Last updated
01/04/2024
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