Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 25128 | TX |
NPI | 1114221611 |
---|---|
Provider Name | Dr. Mimi H. Wright |
First Address | Cranfills Gap, TX 76637-4550 |
Second Address | Cranfills Gap, TX 76637-4550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2010 |
Last Update Date | 27/12/2010 |