Provider Demographics
NPI:1700193448
Name:WEST, JON DAVID (CRNA)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:DAVID
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 1:511 W PRATT ST
Mailing Address - Street 2:2004
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1648
Mailing Address - Country:US
Mailing Address - Phone:503-539-2461
Mailing Address - Fax:
Practice Address - Street 1:511 W PRATT ST
Practice Address - Street 2:2004
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1648
Practice Address - Country:US
Practice Address - Phone:503-539-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190814367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered