Provider Demographics
NPI:1427169226
Name:WEST, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 W 181ST ST APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4555
Mailing Address - Country:US
Mailing Address - Phone:646-952-3177
Mailing Address - Fax:646-219-3299
Practice Address - Street 1:812 W 181ST ST APT 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4555
Practice Address - Country:US
Practice Address - Phone:646-952-3177
Practice Address - Fax:646-219-3299
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420186363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02297794Medicaid