Provider Demographics
NPI:1053388629
Name:WEST, THERESE ANN (RN, APN, C)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:ANN
Last Name:WEST
Suffix:
Gender:F
Credentials:RN, APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 BLANCHARD PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST ALLENHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07711-1304
Mailing Address - Country:US
Mailing Address - Phone:732-531-4861
Mailing Address - Fax:732-695-3077
Practice Address - Street 1:602 BLANCHARD PKWY
Practice Address - Street 2:
Practice Address - City:WEST ALLENHURST
Practice Address - State:NJ
Practice Address - Zip Code:07711-1304
Practice Address - Country:US
Practice Address - Phone:732-531-4861
Practice Address - Fax:732-695-3077
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00050100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine