Provider Demographics
NPI:1649047457
Name:WEST, MARLA ANTOINETTE (LVN)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:ANTOINETTE
Last Name:WEST
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 WHITELOCK PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5927
Mailing Address - Country:US
Mailing Address - Phone:916-695-9227
Mailing Address - Fax:
Practice Address - Street 1:9644 HOLLY GLEN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-8306
Practice Address - Country:US
Practice Address - Phone:916-695-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
CA277360164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No291U00000XLaboratoriesClinical Medical Laboratory