Provider Demographics
NPI:1962942078
Name:WADSWORTH, THELMA RENEE (PA-C, RDH)
Entity type:Individual
Prefix:
First Name:THELMA
Middle Name:RENEE
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:PA-C, RDH
Other - Prefix:
Other - First Name:THELMA
Other - Middle Name:RENEE
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BIEBER
Mailing Address - State:CA
Mailing Address - Zip Code:96009-0277
Mailing Address - Country:US
Mailing Address - Phone:530-294-5392
Mailing Address - Fax:
Practice Address - Street 1:554-850 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BEIBER
Practice Address - State:CA
Practice Address - Zip Code:96009
Practice Address - Country:US
Practice Address - Phone:530-999-9010
Practice Address - Fax:530-294-5392
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7246124Q00000X
CARDH30945124Q00000X
CA61886363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No124Q00000XDental ProvidersDental Hygienist