Provider Demographics
NPI:1558855494
Name:WOODWORTH, KARIN (FNP)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-6316
Mailing Address - Country:US
Mailing Address - Phone:207-478-8258
Mailing Address - Fax:
Practice Address - Street 1:17 JOHNSTON RD
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-6316
Practice Address - Country:US
Practice Address - Phone:207-478-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181114363L00000X
MECNP1181114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner