MEDICARE: MRS. NICOLE MICHELLE MCWHORTER BSHA, C.CHW, CLS, CD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	CHW.002748	OH
2	374J00000X	Doula	DOU000240	OH

General Provider Information

NPI Number	:	1043024086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE MICHELLE MCWHORTER BSHA, C.CHW, CLS, CD

Provider Business Mailing Address
First Line	:	2919 IDA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-2734
Country	:	US
Telephone Number	:	513-402-2696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 IDA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-2734
Country	:	US
Telephone Number	:	513-402-2696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2025
Last Update Date	:	02/24/2026

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