Provider Demographics
NPI:1316963572
Name:WOROCH, RUTH A (NP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:WOROCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 N RAVENSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5802
Mailing Address - Country:US
Mailing Address - Phone:773-432-6570
Mailing Address - Fax:773-681-0839
Practice Address - Street 1:4423 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5802
Practice Address - Country:US
Practice Address - Phone:773-432-6570
Practice Address - Fax:773-681-0839
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP04237Medicare UPIN
ILP04237Medicare UPIN