Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 201802207NP-PP | OR |
NPI | 1093292971 |
---|---|
Provider Name | Tracie Lynn Wright |
First Address | Eagle Point, OR 97524-4405 |
Second Address | Eagle Point, OR 97524-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2018 |
Last Update Date | 05/10/2020 |