Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 021677 | OH |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 272168 | GA |
NPI | 1003327248 |
---|---|
Provider Name | Regina West |
First Address | Lakewood, OH 44107-3908 |
Second Address | Lakewood, OH 44107-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2017 |
Last Update Date | 16/10/2017 |