Healthcare Provider Details

I. General information

NPI: 1992618235
Provider Name (Legal Business Name): DEMAIRE SADE WORTHINGTON APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 576871
MODESTO CA
95357-6871
US

IV. Provider business mailing address

PO BOX 576871
MODESTO CA
95357-6871
US

V. Phone/Fax

Practice location:
  • Phone: 786-637-1972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95406670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: