Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 604423 | TX |
NPI | 1003959057 |
---|---|
Provider Name | Ms. Carolyn Jeanette Wright |
First Address | Pearland, TX 77584-2886 |
Second Address | Houston, TX 77024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86N906 | BLUE CROSS BLUE SHIELD (01) | TX |
P11449 | (02) | TX |