Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1144810722 |
---|---|
Provider Name | Daylynn Mechelle West |
First Address | West Plains, MO 65775-3854 |
Second Address | West Plains, MO 65775-3854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2021 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
65596877 | (05) | MO |