Provider Demographics
NPI:1508946906
Name:WEST, GLORIA R (RN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:R
Last Name:WEST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 KENYON RD
Mailing Address - Street 2:NORTH CENTRAL IOWA MHC DBA BERRYHILL CENTER FOR MENTAL
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:515-955-7171
Mailing Address - Fax:515-573-7898
Practice Address - Street 1:720 KENYON RD
Practice Address - Street 2:NORTH CENTRAL IOWA MHC DBA BERRYHILL CENTER FOR MENTAL
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5759
Practice Address - Country:US
Practice Address - Phone:515-955-7171
Practice Address - Fax:515-573-7898
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA043633163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07466OtherWELLMARK BCBS
IA0159608Medicaid
IA07466OtherWELLMARK BCBS