Healthcare Provider Details

I. General information

NPI: 1902234255
Provider Name (Legal Business Name): ELIZABETH EVA WRIGHT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W SAGINAW RD
SANFORD MI
48657-9206
US

IV. Provider business mailing address

40 W SAGINAW RD
SANFORD MI
48657-9206
US

V. Phone/Fax

Practice location:
  • Phone: 989-687-9940
  • Fax:
Mailing address:
  • Phone: 989-687-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006826
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: