Healthcare Provider Details

I. General information

NPI: 1467558585
Provider Name (Legal Business Name): JOSHUA J WRIGHT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N MARTIN LUTHER KING BLVD
CLOVIS NM
88101
US

IV. Provider business mailing address

PO BOX 98567
LAS VEGAS NV
89193-8567
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-7147
  • Fax:
Mailing address:
  • Phone: 972-715-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 3074232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: