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General NPI Number Information
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NPI Number | 1811649775
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Entity Type | Individual
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Provider Name | NACHELLE WORK RT(R)(T)(CT)
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Gender | Female
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 11 DAVIS WOODS
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City | COLLINSVILLE
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State | IL
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Zip | 62234-7114
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Country | US
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Telephone | 618-604-7453
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Fax |
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Provider Business Mailing Address
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Address Line | 11 DAVIS WOODS
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City | COLLINSVILLE
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State | IL
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Zip | 62234-7114
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Country | US
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Telephone | 618-604-7453
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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 | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number | 451414
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License Number State | IL
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