Provider Demographics
NPI:1366955635
Name:WEST, DANA B (APRN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:B
Last Name:WEST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:BREEDLOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 SIGMA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7722
Mailing Address - Country:US
Mailing Address - Phone:843-302-8840
Mailing Address - Fax:843-818-2188
Practice Address - Street 1:2550 ELMS CENTER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9844
Practice Address - Country:US
Practice Address - Phone:843-302-8840
Practice Address - Fax:843-818-2188
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5009Medicaid