Provider Demographics
NPI:1508363805
Name:WEST, ELODIE VIDEHOUN (NPC)
Entity Type:Individual
Prefix:
First Name:ELODIE
Middle Name:VIDEHOUN
Last Name:WEST
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 ELIZABETH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2212
Mailing Address - Country:US
Mailing Address - Phone:361-884-2858
Mailing Address - Fax:361-879-9015
Practice Address - Street 1:718 ELIZABETH ST FL 3
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2212
Practice Address - Country:US
Practice Address - Phone:361-884-2858
Practice Address - Fax:361-879-9015
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily