Provider Demographics
NPI:1215978812
Name:WEST-CRISP, RAQUEL MARILYN (CNP)
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:MARILYN
Last Name:WEST-CRISP
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2325 KERRY LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-8443
Mailing Address - Country:US
Mailing Address - Phone:630-985-4923
Mailing Address - Fax:
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:2ND FLOOR, GENERAL MEDICINE CLINIC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-6212
Practice Address - Fax:312-864-9318
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health