Provider Demographics
NPI:1710656616
Name:WEST, ANNAZETTA LUCILLE
Entity Type:Individual
Prefix:
First Name:ANNAZETTA
Middle Name:LUCILLE
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 1:5357 HAYES ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7016
Mailing Address - Country:US
Mailing Address - Phone:202-849-1044
Mailing Address - Fax:
Practice Address - Street 1:5357 HAYES ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7016
Practice Address - Country:US
Practice Address - Phone:202-849-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant