Provider Demographics
NPI:1568961506
Name:WORCH, BRITTNEY L
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:L
Last Name:WORCH
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 1:2636 W ESTES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3206
Mailing Address - Country:US
Mailing Address - Phone:773-358-0317
Mailing Address - Fax:
Practice Address - Street 1:2636 W ESTES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3206
Practice Address - Country:US
Practice Address - Phone:773-358-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies