Provider Demographics
NPI:1376534099
Name:WORDEN, GERTRUDE (FNP)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:
Last Name:WORDEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5758
Mailing Address - Country:US
Mailing Address - Phone:315-339-0401
Mailing Address - Fax:315-339-2957
Practice Address - Street 1:117 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5758
Practice Address - Country:US
Practice Address - Phone:315-339-0401
Practice Address - Fax:315-339-2957
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333067-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02087676Medicaid