Provider Demographics
NPI:1073117412
Name:WORDES, LORETTA
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:WORDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 G ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1829
Mailing Address - Country:US
Mailing Address - Phone:707-269-2003
Mailing Address - Fax:707-442-2430
Practice Address - Street 1:537 9TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1861
Practice Address - Country:US
Practice Address - Phone:707-269-2003
Practice Address - Fax:707-442-2430
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker