Provider Demographics
NPI:1255945168
Name:WEST, MICHAEL JOSEPH
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 HOLLEY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CULLODEN
Mailing Address - State:WV
Mailing Address - Zip Code:25510-9359
Mailing Address - Country:US
Mailing Address - Phone:304-761-8403
Mailing Address - Fax:
Practice Address - Street 1:1025 HOLLEY BROOK DR
Practice Address - Street 2:
Practice Address - City:CULLODEN
Practice Address - State:WV
Practice Address - Zip Code:25510-9359
Practice Address - Country:US
Practice Address - Phone:304-761-8403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant