Healthcare Provider Details

I. General information

NPI: 1285841775
Provider Name (Legal Business Name): SANDRA L. WORRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE STE 159
WEST BURLINGTON IA
52655-1686
US

IV. Provider business mailing address

1225 S GEAR AVE STE 159
WEST BURLINGTON IA
52655-1686
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-1570
  • Fax:
Mailing address:
  • Phone: 319-768-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN1497
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125049837
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD49175
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: