MEDICARE: THERESA WEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	VN233284	CA

General Provider Information

NPI Number	:	1356703078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA WEST

Provider Business Mailing Address
First Line	:	145 GLASSON WAY
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12930 GASTON DR
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-9524
Country	:	US
Telephone Number	:	530-470-2425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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Directions to “ THERESA WEST ” Practice Location

Language	Start Address	Practice Location

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