MEDICARE: SHANICE WORTHAM

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	247000000X	Health Information Technician	3981965	NV

General Provider Information

NPI Number	:	1255190146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANICE WORTHAM

Provider Business Mailing Address
First Line	:	25 N 26TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4619
Country	:	US
Telephone Number	:	562-589-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N 26TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4619
Country	:	US
Telephone Number	:	562-589-2344
Fax Number	:

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

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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Directions to “ SHANICE WORTHAM ” Practice Location

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