1487969721 NPI number — MISS MERONICA LATISHA WRIGHT CNA

Table of content: MISS MERONICA LATISHA WRIGHT CNA (NPI 1487969721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487969721 NPI number — MISS MERONICA LATISHA WRIGHT CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
MERONICA
Provider Middle Name:
LATISHA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WRIGHT
Provider Other First Name:
MERONICA
Provider Other Middle Name:
LATISHA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487969721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 W WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 508
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23434-5246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-512-4191
Provider Business Mailing Address Fax Number:
757-512-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 508
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23434-5246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-512-4191
Provider Business Practice Location Address Fax Number:
757-512-4191
Provider Enumeration Date:
08/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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