Provider Demographics
NPI:1114025053
Name:WORTH, CATHERINE L IV
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:WORTH
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 GILMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9377
Mailing Address - Country:US
Mailing Address - Phone:585-293-9489
Mailing Address - Fax:
Practice Address - Street 1:139 GILMAN RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14428-9377
Practice Address - Country:US
Practice Address - Phone:585-293-9489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182377164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse