Healthcare Provider Details

I. General information

NPI: 1942361514
Provider Name (Legal Business Name): CAROL C WEST R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S GILBERT RD
GILBERT AZ
85296-1016
US

IV. Provider business mailing address

140 S GILBERT RD
GILBERT AZ
85296-1016
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-4024
  • Fax: 480-507-1645
Mailing address:
  • Phone: 480-497-4024
  • Fax: 480-507-1645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN061751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: