Healthcare Provider Details

I. General information

NPI: 1770067894
Provider Name (Legal Business Name): TRISHA LYNN WEST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 N SHERIDAN RD FL 6
CHICAGO IL
60657-7227
US

IV. Provider business mailing address

2601 NAVISTAR DR
LISLE IL
60532-3661
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-8400
  • Fax:
Mailing address:
  • Phone: 224-273-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.018188
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10128
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: