1659378727 NPI number — MRS. STACY L WORRELL RNFA

Table of content: MRS. STACY L WORRELL RNFA (NPI 1659378727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659378727 NPI number — MRS. STACY L WORRELL RNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WORRELL
Provider First Name:
STACY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANGEN
Provider Other First Name:
STACY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNFA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659378727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 710793
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43271-0793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-268-9561
Provider Business Mailing Address Fax Number:
614-268-7849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3555 OLENTANGY RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 4000
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43214-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-268-9561
Provider Business Practice Location Address Fax Number:
614-268-7849
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  032526 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: RN-293715 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000337075 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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