Healthcare Provider Details

I. General information

NPI: 1538409495
Provider Name (Legal Business Name): BARBARA J WEST RN, WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 SAINT JOHNS BLVD
JOPLIN MO
64804-1563
US

IV. Provider business mailing address

2817 SAINT JOHNS BLVD
JOPLIN MO
64804-1563
US

V. Phone/Fax

Practice location:
  • Phone: 417-659-6578
  • Fax:
Mailing address:
  • Phone: 417-659-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number123823
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: