Provider Demographics
NPI:1669559282
Name:WEST, VICKI (CRNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 AVIATION BLVD
Mailing Address - Street 2:MS 1178
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21240
Mailing Address - Country:US
Mailing Address - Phone:410-765-6214
Mailing Address - Fax:410-981-8164
Practice Address - Street 1:7323 AVIATION BLVD
Practice Address - Street 2:MS 1178
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21240
Practice Address - Country:US
Practice Address - Phone:410-765-6214
Practice Address - Fax:410-981-8164
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR086919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine