1568777951 NPI number — LATISHA WRIGHT

Table of content: LATISHA WRIGHT (NPI 1568777951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568777951 NPI number — LATISHA WRIGHT

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568777951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3154
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27519-3154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-909-5153
Provider Business Mailing Address Fax Number:
919-462-0410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3811 N ROXBORO ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27704-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-797-0428
Provider Business Practice Location Address Fax Number:
919-797-0448
Provider Enumeration Date:
08/10/2010

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: 111N00000X , with the licence number:  3938 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 3459 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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