=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053715524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONA WEST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2014
-----------------------------------------------------
Last Update Date | 01/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7116 PARK HEIGHTS AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21215-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-322-0901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 W BEL AIR AVE STE 106
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21001-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-910-7930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | A00044687
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------