Healthcare Provider Details

I. General information

NPI: 1215048467
Provider Name (Legal Business Name): TRESA DAWN WORSTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLUE VALLEY MENTAL HEALTH CENTER 1123 N 9TH ST
BEATRICE NE
68310
US

IV. Provider business mailing address

72380 578TH AVE
PLYMOUTH NE
68424
US

V. Phone/Fax

Practice location:
  • Phone: 402-228-3386
  • Fax: 402-228-2004
Mailing address:
  • Phone: 402-656-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number54057
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: