Provider Demographics
NPI:1548597792
Name:WEST, TINA L
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:L
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 1:148 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ROTHSAY
Mailing Address - State:MN
Mailing Address - Zip Code:56579-4125
Mailing Address - Country:US
Mailing Address - Phone:218-731-2926
Mailing Address - Fax:
Practice Address - Street 1:148 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ROTHSAY
Practice Address - State:MN
Practice Address - Zip Code:56579-4125
Practice Address - Country:US
Practice Address - Phone:218-731-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCOMPLIMENTRY175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath