Provider Demographics
NPI:1104969658
Name:WORRALL, MICHELE M (RN, BSN,)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:M
Last Name:WORRALL
Suffix:
Gender:F
Credentials:RN, BSN,
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:WORRALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3325 S TULARE CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4367
Mailing Address - Country:US
Mailing Address - Phone:303-283-9562
Mailing Address - Fax:
Practice Address - Street 1:2045 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5437
Practice Address - Country:US
Practice Address - Phone:303-764-5098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO55462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC3235Medicare PIN