Provider Demographics
NPI:1215089768
Name:WEST, SHANNON KAY (CFA, CST)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAY
Last Name:WEST
Suffix:
Gender:F
Credentials:CFA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BARNEY DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3546
Mailing Address - Country:US
Mailing Address - Phone:208-709-2063
Mailing Address - Fax:
Practice Address - Street 1:3155 CHANNING WAY
Practice Address - Street 2:SUITE B
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7561
Practice Address - Country:US
Practice Address - Phone:208-535-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID102652OtherCST, CFA