Healthcare Provider Details

I. General information

NPI: 1598381907
Provider Name (Legal Business Name): NIESHIA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WERTZ AVE SW
CANTON OH
44710-2404
US

IV. Provider business mailing address

201 WERTZ AVE SW
CANTON OH
44710-2404
US

V. Phone/Fax

Practice location:
  • Phone: 330-412-7803
  • Fax:
Mailing address:
  • Phone: 330-412-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberPN-113710
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: