Provider Demographics
NPI:1194966010
Name:WEST, NORTH EDWARD (LAC)
Entity type:Individual
Prefix:MR
First Name:NORTH
Middle Name:EDWARD
Last Name:WEST
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17087-9760
Mailing Address - Country:US
Mailing Address - Phone:717-866-4908
Mailing Address - Fax:
Practice Address - Street 1:99 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:PA
Practice Address - Zip Code:17087-9760
Practice Address - Country:US
Practice Address - Phone:717-866-4908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000838171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAK000838OtherSTATE LICENSE ACUPUNCTURIST