1184887929 NPI number — MRS. DARRALYN DELLICE WRIGHT LPN

Table of content: MRS. DARRALYN DELLICE WRIGHT LPN (NPI 1184887929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184887929 NPI number — MRS. DARRALYN DELLICE WRIGHT LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
DARRALYN
Provider Middle Name:
DELLICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOHANAN
Provider Other First Name:
DARRALYN
Provider Other Middle Name:
DELLICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184887929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87 PAXTON AVE
Provider Second Line Business Mailing Address:
APT.3N
Provider Business Mailing Address City Name:
CALUMET CITY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60409-1557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-566-0324
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87 PAXTON AVE
Provider Second Line Business Practice Location Address:
APT.3N
Provider Business Practice Location Address City Name:
CALUMET CITY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60409-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-566-0324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2008

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: 164W00000X , with the licence number:  PN101904 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 164W00000X , with the licence number: 27070140A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: 043080115 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2686473 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".