Provider Demographics
NPI:1598463291
Name:WORRELLS, DAJON (EMT-B)
Entity Type:Individual
Prefix:
First Name:DAJON
Middle Name:
Last Name:WORRELLS
Suffix:
Gender:F
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W GODFREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1410
Mailing Address - Country:US
Mailing Address - Phone:484-862-9394
Mailing Address - Fax:
Practice Address - Street 1:4871 SUMMERDALE AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2342
Practice Address - Country:US
Practice Address - Phone:267-760-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0889073146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic