Healthcare Provider Details

I. General information

NPI: 1528172194
Provider Name (Legal Business Name): ILEEN MARIE WRIGHT APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA GLA HEALTHCARE SYSTEM 11301 WILSHIRE BLVD. 11301 WILSHIRE BLVD.
LOS ANGELES CA
90073
US

IV. Provider business mailing address

410 S BARRINGTON AVE #402
LOS ANGELES CA
90049-6436
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone: 310-478-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number24
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number058907
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number058907
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: