Provider Demographics
NPI:1609518414
Name:WORCHUCK, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WORCHUCK
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 1:728 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1409
Mailing Address - Country:US
Mailing Address - Phone:419-605-2870
Mailing Address - Fax:
Practice Address - Street 1:540 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1950
Practice Address - Country:US
Practice Address - Phone:419-796-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant