Doctor Name: | MR. RUSSELL NATHAN WORTHEN |
NPI Number: | 1093190795 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP-C |
License Number: | 5007800 |
Business Practice Address: | 1370 W D St North Wilkesboro, NC - 286593506 |
Business Phone Number: | 3366518083 |
Business Fax Number: | |
Mailing Address: | Medical Center Blvd, WINSTON SALEM |
State: | NC |
Postal Code: | 271570001 |
Phone Number: | 3367162011 |
Fax Number: | |
NPI Enumeration Date: | 07/23/2015 |
NPI Last Update Date: | 07/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5007800 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |