Healthcare Provider Details

I. General information

NPI: 1518082288
Provider Name (Legal Business Name): BARBARA A WORTMAN R.N.F.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21134 LOWLAND AVE
EAGLE RIVER AK
99577-9584
US

IV. Provider business mailing address

PO BOX 241769
ANCHORAGE AK
99524-1769
US

V. Phone/Fax

Practice location:
  • Phone: 907-696-7670
  • Fax: 907-550-6179
Mailing address:
  • Phone: 907-770-2301
  • Fax: 907-770-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number16761
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number16761
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: