Provider Demographics
NPI:1477217099
Name:WORTHAM, LYCURTIS
Entity Type:Individual
Prefix:
First Name:LYCURTIS
Middle Name:
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 47TH ST SE # 51
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-8412
Mailing Address - Country:US
Mailing Address - Phone:202-997-0807
Mailing Address - Fax:
Practice Address - Street 1:5201 HAYES ST NE APT 322
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5571
Practice Address - Country:US
Practice Address - Phone:202-868-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant