Individual
RUSSELL G WORTHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 E 100 N, PAYSON, UT 84651-1600
(800) 748-4868
(801) 733-5872
Mailing address
383 W 1600 S, PAYSON, UT 84651-8614
(801) 465-2424
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
361659-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107043317101
IHC
UT
01
—
67790
HEALTHY U
UT
01
—
QMP000003333387
MOLINA
UT
Enumeration date
09/12/2006
Last updated
07/08/2007
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