Provider Demographics
NPI:1891764593
Name:WORCESTER, PAULETTE I (CFNP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:I
Last Name:WORCESTER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8802
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:950 N MARKET ST
Practice Address - Street 2:UNION COUNTY MEDICAL CENTER
Practice Address - City:LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:47353-8496
Practice Address - Country:US
Practice Address - Phone:765-458-5191
Practice Address - Fax:765-458-7301
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.04953-NP363LF0000X
IN71000692A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200360880Medicaid
IN000000681077OtherANTHEM BCBS
INM400020856Medicare PIN