MEDICARE: MRS. DIANA LYNN WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1174776637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA LYNN WRIGHT

Provider Business Mailing Address
First Line	:	971 WOODLINE AVE
Second Line	:
City	:	NORTH LAWRENCE
State	:	OH
Zip	:	44666-9714
Country	:	US
Telephone Number	:	330-832-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 WOODLINE AVE
Second Line	:
City	:	NORTH LAWRENCE
State	:	OH
Zip	:	44666-9714
Country	:	US
Telephone Number	:	330-832-8008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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