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General NPI Number Information
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NPI Number | 1912221466
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Entity Type | Individual
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Provider Name | MRS. WALENTYNA WORONKO
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Gender | Female
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 1 INGALLS DR
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City | HARVEY
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State | IL
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Zip | 60426-3558
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Country | US
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Telephone | 170-886-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 13054 S HOUSTON AVE
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City | CHICAGO
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State | IL
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Zip | 60633-1705
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Country | US
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Telephone | 17736464066
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 056.005196
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License Number State | IL
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