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NPI Code Detail

MEDICARE: JOHN CLARENDON WORTHINGTON RN

MEDICARE: JOHN CLARENDON WORTHINGTON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse391361CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13911361OTHERCARN

General Provider Information

NPI Number : 1487284980
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN CLARENDON WORTHINGTON RN
Provider Business Mailing Address
First Line : PO BOX 1449
Second Line :
City : UKIAH
State : CA
Zip : 95482-1449
Country : US
Telephone Number : 707-462-2501
Fax Number :
Provider Business Practice Location Address
First Line : 516 CYPRESS ST
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-5410
Country : US
Telephone Number : 707-472-0350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2020
Last Update Date : 07/01/2024

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