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General NPI Number Information
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NPI Number | 1588782122
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Entity Type | Individual
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Provider Name | MRS. MICHELE DAWN WORTHINGTON
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3221 STATE ROUTE 139
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City | PORTSMOUTH
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State | OH
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Zip | 45662-8849
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Country | US
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Telephone | 740-456-6537
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Fax |
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Provider Business Mailing Address
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Address Line | 3221 STATE ROUTE 139
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City | PORTSMOUTH
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State | OH
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Zip | 45662-8849
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Country | US
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Telephone | 740-456-6537
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 370047420601
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License Number State | OH
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