Provider Demographics
NPI:1356814156
Name:WEST, DANIEL HUGH (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HUGH
Last Name:WEST
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2199 MALLARD POND RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-8123
Mailing Address - Country:US
Mailing Address - Phone:678-378-6145
Mailing Address - Fax:
Practice Address - Street 1:4960 NORTON HEALTHCARE BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2831
Practice Address - Country:US
Practice Address - Phone:502-446-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA227560163W00000X
KY3013188367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse