Provider Demographics
NPI:1861790107
Name:WEST, WENDY MICHELE (RN)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MICHELE
Last Name:WEST
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 1:328 W CLAIBORNE ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-1738
Mailing Address - Country:US
Mailing Address - Phone:251-575-4837
Mailing Address - Fax:251-575-9459
Practice Address - Street 1:530 HORNADY DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-8658
Practice Address - Country:US
Practice Address - Phone:251-575-4837
Practice Address - Fax:251-575-9459
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126995163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630636696Medicaid