Provider Demographics
NPI:1487988242
Name:WEST, AMY L (FNPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:MYSHRALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:PENOBSCOT COMMUNITY HEALTH CENTER
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:992 UNION ST STE 3
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3057
Practice Address - Country:US
Practice Address - Phone:207-404-8330
Practice Address - Fax:207-307-3903
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP161180363L00000X, 363L00000X
MARN2259956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily