Provider Demographics
NPI:1376824417
Name:WEST, LISA M (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:GA
Mailing Address - Zip Code:30179-0537
Mailing Address - Country:US
Mailing Address - Phone:770-826-1590
Mailing Address - Fax:770-573-1935
Practice Address - Street 1:362 B COLUMBIA DRIVE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:770-755-5304
Practice Address - Fax:770-573-1935
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137895163WH0500X, 363LF0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily