Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 19208 | SC |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 19208 | SC |
NPI | 1023406774 |
---|---|
Provider Name | Demetris Wright |
First Address | Columbia, SC 29229-7839 |
Second Address | Greenville, SC 29611-3850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2015 |
Last Update Date | 30/07/2021 |