Provider Demographics
NPI:1063958684
Name:WEST, HANNAH V (PA-C)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:V
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 N HALSTED ST STE 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2615
Mailing Address - Country:US
Mailing Address - Phone:773-388-6390
Mailing Address - Fax:312-867-7101
Practice Address - Street 1:1460 N HALSTED ST STE 501
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2615
Practice Address - Country:US
Practice Address - Phone:773-388-6390
Practice Address - Fax:312-867-7101
Is Sole Proprietor?:No
Enumeration Date:2017-01-07
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60705480363A00000X
IL085.005988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant