Basic Information
| Provider Information | |||||||||
| NPI: | 1891764593 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORCESTER | ||||||||
| FirstName: | PAULETTE | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 REID PKWY | ||||||||
| Address2: | MEDICAL STAFF SERVICES | ||||||||
| City: | RICHMOND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473741157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659358802 | ||||||||
| FaxNumber: | 7659833219 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 N MARKET ST | ||||||||
| Address2: | UNION COUNTY MEDICAL CENTER | ||||||||
| City: | LIBERTY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473538496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654585191 | ||||||||
| FaxNumber: | 7654587301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA.04953-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 71000692A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200360880 | 05 | IN | MEDICAID | 000000681077 | 01 | IN | ANTHEM BCBS | OTHER |