Healthcare Provider Details

I. General information

NPI: 1356594741
Provider Name (Legal Business Name): ELIZABETH WEST LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 JACKSON MILLS RD
FREEHOLD NJ
07728-8061
US

IV. Provider business mailing address

302 JACKSON MILLS RD
FREEHOLD NJ
07728-8061
US

V. Phone/Fax

Practice location:
  • Phone: 800-950-6066
  • Fax:
Mailing address:
  • Phone: 800-950-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP05285300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: