Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 71007595A | IN |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 71007595A | IN |
NPI | 1043722622 |
---|---|
Provider Name | Ms. Amara Donella Wright-Terry |
First Address | Highland, IN 46322-3616 |
Second Address | Highland, IN 46322-3616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2017 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300011528 | (05) | IN |