Active NPI
Ebonnie Camille West, A.T.C
- Athletic Trainer
- Southfield, MI
National Provider Identifier
1598809428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 010702102
- Practice address
- 24901 Northwestern Hwy
Southfield, MI 48075-2203 - Phone
- (248) 358-3001
- NPI assigned
- Feb 16, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 010702102 | NE | Primary |
Addresses
Primary practice location
24901 Northwestern Hwy
Southfield, MI 48075-2203
Mailing address
18400 Lauder St
Detroit, MI 48235-2737
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010702102 | NE | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598809428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18400 LAUDER ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482352737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24901 NORTHWESTERN HWY",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480752203",
"telephone_number": "248-358-3001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEST",
"first_name": "EBONNIE",
"middle_name": "CAMILLE",
"name_prefix": "Ms.",
"credential": "A.T.C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NE",
"license": "010702102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.