Healthcare Provider Details

I. General information

NPI: 1114542271
Provider Name (Legal Business Name): MR. PAUL WORSFOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 06/14/2020
Certification Date: 06/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23290 YORK AVE
PARKER CO
80138-8787
US

IV. Provider business mailing address

23290 YORK AVE
PARKER CO
80138-8787
US

V. Phone/Fax

Practice location:
  • Phone: 303-946-5565
  • Fax:
Mailing address:
  • Phone: 303-946-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number108662
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: