Healthcare Provider Details

I. General information

NPI: 1396005674
Provider Name (Legal Business Name): MARY ELIZABETH WRIGHT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E ELDER ST STE 104
FALLBROOK CA
92028-3081
US

IV. Provider business mailing address

31889 HONEYSUCKLE CIR
WINCHESTER CA
92596-8729
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-9560
  • Fax: 760-728-9020
Mailing address:
  • Phone: 951-566-5229
  • Fax: 951-566-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP21718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: