Provider Demographics
NPI:1164643730
Name:WEST, SHIRLEY MAE (RN, CCM)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MAE
Last Name:WEST
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7358 THOMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247
Mailing Address - Country:US
Mailing Address - Phone:513-353-3366
Mailing Address - Fax:513-353-3366
Practice Address - Street 1:5555 GLENDON COURT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016
Practice Address - Country:US
Practice Address - Phone:513-385-2742
Practice Address - Fax:513-385-2746
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 206103163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1059645OtherKENTUCKY RN LICENSURE
OHRN 206103OtherOHIO RN LICENSURE
IN28151935AOtherINDIANA RN LICENSURE