MEDICARE: NICOLE 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	2255A2300X	Athletic Trainer		CA

General Provider Information

NPI Number	:	1639552573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WRIGHT

Provider Business Mailing Address
First Line	:	2710 KING GEORGE CT
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4113
Country	:	US
Telephone Number	:	530-558-5757
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 12TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4411
Country	:	US
Telephone Number	:	530-558-5727
Fax Number	:

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

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	07/08/2015

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Directions to “ NICOLE WRIGHT ” Practice Location

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