Provider Demographics
NPI:1659378727
Name:WORRELL, STACY L (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:L
Last Name:WORRELL
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:HANGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNFA
Mailing Address - Street 1:PO BOX 710793
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0793
Mailing Address - Country:US
Mailing Address - Phone:614-268-9561
Mailing Address - Fax:614-268-7849
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 4000
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-268-9561
Practice Address - Fax:614-268-7849
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032526174400000X
OHRN-293715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000337075OtherANTHEM PIN