Healthcare Provider Details

I. General information

NPI: 1063651578
Provider Name (Legal Business Name): TERUKO MICHELLE WRIGHT LMBT,NCTMB,CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2009
Last Update Date: 02/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 WATERFORD CLUB XING #228
RALEIGH NC
27612-7814
US

IV. Provider business mailing address

4811 WATERFORD CLUB XING #228
RALEIGH NC
27612-7814
US

V. Phone/Fax

Practice location:
  • Phone: 919-785-5066
  • Fax:
Mailing address:
  • Phone: 919-785-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number07879
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number300931
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number300931
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: