Healthcare Provider Details

I. General information

NPI: 1043795370
Provider Name (Legal Business Name): TERREN COURTNEY WORTHAM DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 N 40TH ST STE 157
PHOENIX AZ
85032-4683
US

IV. Provider business mailing address

1755 N PEBBLE CREEK PKWY # 1072
GOODYEAR AZ
85395-2532
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-1001
  • Fax:
Mailing address:
  • Phone: 602-529-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number265258
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: