1699710640 NPI number — TENIESHA NICOLE WRIGHT-JONES DO

Table of content: TENIESHA NICOLE WRIGHT-JONES DO (NPI 1699710640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699710640 NPI number — TENIESHA NICOLE WRIGHT-JONES DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT-JONES
Provider First Name:
TENIESHA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
TENIESHA
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699710640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43750 GARFIELD RD
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-1135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-996-9975
Provider Business Mailing Address Fax Number:
586-228-4533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22250 PROVIDENCE DR STE 500
Provider Second Line Business Practice Location Address:
DEIGHTON FAMILY PRACTICE
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-6213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-849-3441
Provider Business Practice Location Address Fax Number:
248-849-5389
Provider Enumeration Date:
06/16/2006

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: 207Q00000X , with the licence number:  5101015647 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4914353/11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080F3342800 . This is a "BCBSM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700E012740 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".