Individual
MR. RUSSELL NATHAN LUDWIG WORTHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-3506
(336) 716-2011
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
5007800
NC
363LF0000X
Family Nurse Practitioner
5007800
NC
Other
Enumeration date
07/23/2015
Last updated
04/03/2024
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