Healthcare Provider Details

I. General information

NPI: 1114316296
Provider Name (Legal Business Name): DEBRINA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NEWBURY ST 3RD FLR
BOSTON MA
02116-3236
US

IV. Provider business mailing address

PO BOX 990993
BOSTON MA
02199-0993
US

V. Phone/Fax

Practice location:
  • Phone: 617-717-9551
  • Fax:
Mailing address:
  • Phone: 617-717-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number14048934
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: