Provider Demographics
NPI:1043794795
Name:WEST, TRACEY LARDELLA
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LARDELLA
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LARDELLA
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2801 WYANDOTTE ST APT 25
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-6411
Mailing Address - Country:US
Mailing Address - Phone:424-212-0320
Mailing Address - Fax:
Practice Address - Street 1:U S NATIONAL PERSONAL CARE LLC
Practice Address - Street 2:2881 S VALLEY VIEW BLVD STE 6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-253-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant