Provider Demographics
NPI:1720227663
Name:WEST, ERIC ANTHONY (RN)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANTHONY
Last Name:WEST
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22650 FAIRMONT DRIVE
Mailing Address - Street 2:303
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335
Mailing Address - Country:US
Mailing Address - Phone:248-426-9555
Mailing Address - Fax:
Practice Address - Street 1:19275 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2220
Practice Address - Country:US
Practice Address - Phone:734-785-7705
Practice Address - Fax:734-287-1679
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246077163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse