Healthcare Provider Details

I. General information

NPI: 1659378727
Provider Name (Legal Business Name): STACY L WORRELL RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: STACY L HANGEN RNFA

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER RD SUITE 4000
COLUMBUS OH
43214-3912
US

IV. Provider business mailing address

PO BOX 710793
COLUMBUS OH
43271-0793
US

V. Phone/Fax

Practice location:
  • Phone: 614-268-9561
  • Fax: 614-268-7849
Mailing address:
  • Phone: 614-268-9561
  • Fax: 614-268-7849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number032526
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRN-293715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: