Provider Demographics
NPI:1184003162
Name:WEST, KRISTINA
Entity Type:Individual
Prefix:
First Name:KRISTINA
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 1:1114 N GROW RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9722
Mailing Address - Country:US
Mailing Address - Phone:616-232-3894
Mailing Address - Fax:
Practice Address - Street 1:1114 N GROW RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9722
Practice Address - Country:US
Practice Address - Phone:616-232-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-24
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other