Healthcare Provider Details

I. General information

NPI: 1003147224
Provider Name (Legal Business Name): YVONNE WRIGHT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 E 10 MILE RD SUITE 165
EASTPOINTE MI
48021-3355
US

IV. Provider business mailing address

25650 OUTER DR SUITE 401
LINCOLN PARK MI
48146-2096
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005639
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: