Provider Demographics
NPI:1518586007
Name:WORLEY, PAIGE (MS, RD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:WORLEY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 RODEO WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4134
Mailing Address - Country:US
Mailing Address - Phone:949-293-0955
Mailing Address - Fax:
Practice Address - Street 1:3905 N 36TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-5634
Practice Address - Country:US
Practice Address - Phone:949-293-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61052340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered