Provider Demographics
NPI:1710089479
Name:WEST, WENSI NATASHA (LMT)
Entity Type:Individual
Prefix:
First Name:WENSI
Middle Name:NATASHA
Last Name:WEST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 COLEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1728
Mailing Address - Country:US
Mailing Address - Phone:850-527-0521
Mailing Address - Fax:850-638-3772
Practice Address - Street 1:4440 LAFAYETTE ST STE K
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3411
Practice Address - Country:US
Practice Address - Phone:850-527-0521
Practice Address - Fax:850-638-3772
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3841OtherBC/BS