Provider Demographics
NPI:1558400721
Name:WORSHAM, VANESSA (MSN, APRN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:WORSHAM
Suffix:
Gender:F
Credentials:MSN, APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LEGACY WAY
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5689
Mailing Address - Country:US
Mailing Address - Phone:888-826-2776
Mailing Address - Fax:888-233-1716
Practice Address - Street 1:129 LEGACY WAY
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5689
Practice Address - Country:US
Practice Address - Phone:888-826-2776
Practice Address - Fax:888-233-1716
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1009630364SA2200X
TX640929364SA2200X
FLCNS9301281364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health