Provider Demographics
NPI:1972834224
Name:WORTHINGTON, ELAINE MARIS
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARIS
Last Name:WORTHINGTON
Suffix:
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 1:744 STILSON RD
Mailing Address - Street 2:
Mailing Address - City:HUNT
Mailing Address - State:NY
Mailing Address - Zip Code:14846-9763
Mailing Address - Country:US
Mailing Address - Phone:585-476-5607
Mailing Address - Fax:
Practice Address - Street 1:744 STILSON RD
Practice Address - Street 2:
Practice Address - City:HUNT
Practice Address - State:NY
Practice Address - Zip Code:14846-9763
Practice Address - Country:US
Practice Address - Phone:585-476-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2120881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse