Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 49721 | OK |
N | 363LW0102X | Nurse Practitioner - Women's Health | R0049721 | OK |
NPI | 1144321456 |
---|---|
Provider Name | Deanna Elizabeth Wright |
First Address | Tahlequah, OK 74465-1008 |
Second Address | Tahlequah, OK 74464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 13/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200054520A | (05) | OK |
S89588 | (02) | OK |