Provider Demographics
NPI:1942465935
Name:JAWOROWICZ, CAROL ANNE (RN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:JAWOROWICZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 W WYNDHAM HILL DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-7115
Mailing Address - Country:US
Mailing Address - Phone:616-822-7508
Mailing Address - Fax:
Practice Address - Street 1:516 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4702
Practice Address - Country:US
Practice Address - Phone:616-456-6135
Practice Address - Fax:616-771-9779
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704112531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P51090Medicare UPIN