Provider Demographics
NPI:1790836609
Name:WEST, ELIZABETH (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:WEST
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1306 MAPLE CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7106
Mailing Address - Country:US
Mailing Address - Phone:478-244-1995
Mailing Address - Fax:
Practice Address - Street 1:1306 MAPLE CREEK AVE
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7106
Practice Address - Country:US
Practice Address - Phone:478-244-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN090771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily