Healthcare Provider Details

I. General information

NPI: 1235202508
Provider Name (Legal Business Name): NANCY JANE WRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEVENTH STREET LAS VEGAS CLINIC FOR CHILDREN & YOUTH
LAS VEGAS NM
87701
US

IV. Provider business mailing address

501 SEVENTH STREET LAS VEGAS CLINIC FOR CHILDREN & YOUTH
LAS VEGAS NM
87701
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-3566
  • Fax: 505-425-3568
Mailing address:
  • Phone: 505-425-3566
  • Fax: 505-425-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20020422
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: