Healthcare Provider Details

I. General information

NPI: 1417924614
Provider Name (Legal Business Name): ELISA M WRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVENUE SOUTH SUITE 540
EDINA MN
55435
US

IV. Provider business mailing address

6545 FRANCE AVENUE SOUTH SUITE 540
EDINA MN
55435
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-4045
  • Fax: 952-924-4133
Mailing address:
  • Phone: 952-927-4045
  • Fax: 952-924-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number270704
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number270704
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: