Individual
NICOLE WADSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7123 PEARL RD, MIDDLEBURG HEIGHTS, OH 44130-4975
(440) 842-7990
(440) 842-8835
Mailing address
2 WARWICK LN, ATHENS, OH 45701-3368
(740) 707-4598
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34.007038
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2184523
—
OH
01
—
942460636917
CARESOURCE
OH
01
—
P00285501
MEDICARE RR-GA
OH
Enumeration date
07/25/2006
Last updated
08/15/2016
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