Healthcare Provider Details

I. General information

NPI: 1528507506
Provider Name (Legal Business Name): RHONDA WEST AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2723 S 7TH ST STE C
TERRE HAUTE IN
47802-3558
US

IV. Provider business mailing address

2723 S 7TH ST STE A
TERRE HAUTE IN
47802-3558
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-5936
  • Fax: 812-235-1290
Mailing address:
  • Phone: 812-238-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number28146683A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: