Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036.056291 | IL |
NPI | 1023336922 |
---|---|
Provider Name | Dr. Judy Lee Wright |
First Address | Bloomington, IL 61701-4143 |
Second Address | Bloomington, IL 61701-4143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 17/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C37311 | (02) | IL |