Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 020608 | OH |
NPI | 1003356882 |
---|---|
Provider Name | Myra Wright |
First Address | Middletown, OH 45005-2584 |
Second Address | Middletown, OH 45005-2584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2017 |
Last Update Date | 23/05/2017 |