Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 71011773A | IN |
N | 207QA0505X | Family Doctor - Adult Medicine | 209.023477 | IL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71011773A | IN |
NPI | 1346914884 |
---|---|
Provider Name | Erin Wright |
First Address | Munster, IN 46321-1514 |
Second Address | Merrillville, IN 46410-1675 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2021 |
Last Update Date | 28/10/2021 |