Healthcare Provider Details

I. General information

NPI: 1073024782
Provider Name (Legal Business Name): FLORENCE MASEDA WRIGHT RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 14TH ST
MERIDIAN MS
39301-4040
US

IV. Provider business mailing address

2124 14TH ST
MERIDIAN MS
39301-4040
US

V. Phone/Fax

Practice location:
  • Phone: 601-553-6000
  • Fax: 601-703-0124
Mailing address:
  • Phone: 601-703-3480
  • Fax: 601-703-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number762061
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: