Provider Demographics
NPI:1174559413
Name:WARFIELD, CAROL RAE
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:RAE
Last Name:WARFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:RAE
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, FNP
Mailing Address - Street 1:1207 NETWORK CENTRE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4632
Mailing Address - Country:US
Mailing Address - Phone:217-347-2707
Mailing Address - Fax:217-347-2827
Practice Address - Street 1:512 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2005
Practice Address - Country:US
Practice Address - Phone:217-347-7030
Practice Address - Fax:217-347-7049
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041112424OtherRN LICENSE
IL209000684OtherNURSE PRACTITIONER LICENSE
IL309000228OtherNURSE PRACTITIONER CONTROLLED SUBS LICENSE
IL309000228OtherNURSE PRACTITIONER CONTROLLED SUBS LICENSE
IL041112424OtherRN LICENSE
IL209000684OtherNURSE PRACTITIONER LICENSE