Provider Demographics
NPI:1164236378
Name:WORTHMAN, HEIDI J (RN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:WORTHMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8417
Mailing Address - Country:US
Mailing Address - Phone:518-879-4209
Mailing Address - Fax:
Practice Address - Street 1:100 SARATOGA VILLAGE BLVD STE 9
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3703
Practice Address - Country:US
Practice Address - Phone:518-886-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY469446163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty