MEDICARE: LASEAN E WORTHY

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	374J00000X	Doula

General Provider Information

NPI Number	:	1922834506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASEAN E WORTHY

Provider Business Mailing Address
First Line	:	789 LYMAN AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1624
Country	:	US
Telephone Number	:	614-928-2910
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 LYMAN AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1624
Country	:	US
Telephone Number	:	614-928-2910
Fax Number	:

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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Directions to “ LASEAN E WORTHY ” Practice Location

Language	Start Address	Practice Location

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