Healthcare Provider Details

I. General information

NPI: 1144697061
Provider Name (Legal Business Name): ANNA WEST P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 S SHERIDAN RD
STANTON MI
48888-9285
US

IV. Provider business mailing address

2939 S SHERIDAN RD
STANTON MI
48888-9285
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-9009
  • Fax: 989-831-9150
Mailing address:
  • Phone: 989-831-9009
  • Fax: 989-831-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601002191
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: