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NPI Code Detail

MEDICARE: MRS. STACY L WORRELL RNFA

MEDICARE: MRS. STACY L WORRELL RNFA
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
1174400000XSpecialist032526OH
2174400000XSpecialistRN-293715OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000337075OTHEROHANTHEM PIN

General Provider Information

NPI Number : 1659378727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY L WORRELL RNFA
Provider Business Mailing Address
First Line : PO BOX 710793
Second Line :
City : COLUMBUS
State : OH
Zip : 43271-0793
Country : US
Telephone Number : 614-268-9561
Fax Number : 614-268-7849
Provider Business Practice Location Address
First Line : 3555 OLENTANGY RIVER RD
Second Line : SUITE 4000
City : COLUMBUS
State : OH
Zip : 43214-3912
Country : US
Telephone Number : 614-268-9561
Fax Number : 614-268-7849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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