Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP181156 | ME |
NPI | 1013930056 |
---|---|
Provider Name | Ms. Mitzi L Wright |
First Address | Bangor, ME 04402-1599 |
Second Address | Old Town, ME 04468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 13/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P95381 | (02) | TN |