Provider Demographics
NPI:1689604977
Name:WEST, JILL A (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14155 N 83RD AVE
Mailing Address - Street 2:SUITE #110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5639
Mailing Address - Country:US
Mailing Address - Phone:623-215-0911
Mailing Address - Fax:623-215-0912
Practice Address - Street 1:14155 N 83RD AVE
Practice Address - Street 2:SUITE #110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5639
Practice Address - Country:US
Practice Address - Phone:623-215-0911
Practice Address - Fax:623-215-0912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3074363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical