Provider Demographics
NPI:1992765150
Name:WEST, JANET IRENE (PA)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:IRENE
Last Name:WEST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:IRENE
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1721 N LEE TREVINO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4563
Mailing Address - Country:US
Mailing Address - Phone:915-590-9424
Mailing Address - Fax:915-590-9044
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-200-2371
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-0023363AM0700X
TXPA07797363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
538858YMVUOtherWELLMED NETWORKS INC