MEDICARE: NICOLE WADSWORTH DO

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	207P00000X	Emergency Medicine Physician	34.007038	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00285501	OTHER	OH	MEDICARE RR-GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	942460636917	OTHER	OH	CARESOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487677290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WADSWORTH DO

Provider Business Mailing Address
First Line	:	2 WARWICK LN
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-3368
Country	:	US
Telephone Number	:	740-707-4598
Fax Number	:

Provider Business Practice Location Address
First Line	:	7123 PEARL RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4975
Country	:	US
Telephone Number	:	440-842-7990
Fax Number	:	440-842-8835

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/15/2016

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Directions to “ NICOLE WADSWORTH DO” Practice Location

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