Provider Demographics
NPI:1760515308
Name:WORLEY, VANESSA HELEN (PA-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:HELEN
Last Name:WORLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35006
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-5006
Mailing Address - Country:US
Mailing Address - Phone:330-494-2097
Mailing Address - Fax:330-494-9750
Practice Address - Street 1:4105 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2531
Practice Address - Country:US
Practice Address - Phone:330-494-2097
Practice Address - Fax:330-494-9750
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051830363AS0400X
OH50.002724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical