Provider Demographics
NPI:1215048467
Name:WORSTER, TRESA DAWN (RN)
Entity type:Individual
Prefix:MRS
First Name:TRESA
Middle Name:DAWN
Last Name:WORSTER
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 1:72380 578TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68424
Mailing Address - Country:US
Mailing Address - Phone:402-656-3130
Mailing Address - Fax:
Practice Address - Street 1:BLUE VALLEY MENTAL HEALTH CENTER 1123 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310
Practice Address - Country:US
Practice Address - Phone:402-228-3386
Practice Address - Fax:402-228-2004
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470528515-80Medicaid