Basic Information
| Provider Information | |||||||||
| NPI: | 1609518414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORCHUCK | ||||||||
| FirstName: | DONNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 728 E 4TH ST | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458751409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196052870 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458751950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197960306 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2022 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | Y | Nursing Service Related Providers | Technician | Personal Care Attendant |
No ID Information.