Healthcare Provider Details

I. General information

NPI: 1558986489
Provider Name (Legal Business Name): DENISE WEST BSN, RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE WEST BSN, RN, CDCES

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S PINNACLE HILLS PKWY STE 300B
ROGERS AR
72758-9000
US

IV. Provider business mailing address

3333 S PINNACLE HILLS PKWY STE 300B
ROGERS AR
72758-9000
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-6086
  • Fax: 479-338-4630
Mailing address:
  • Phone: 479-338-6086
  • Fax: 479-338-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR103505
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: