Basic Information
| Provider Information | |||||||||
| NPI: | 1063958684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1460 N HALSTED ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606422615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733886390 | ||||||||
| FaxNumber: | 3128677101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1460 N HALSTED ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606422615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733886390 | ||||||||
| FaxNumber: | 3128677101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2017 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA60705480 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 085.005988 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.