Healthcare Provider Details

I. General information

NPI: 1760381479
Provider Name (Legal Business Name): RAE ANN C WRIGHT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3456 LIBERTY ST
ASHTABULA OH
44004-5969
US

IV. Provider business mailing address

2630 W 13TH ST
ASHTABULA OH
44004-2405
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-7321
  • Fax:
Mailing address:
  • Phone: 440-576-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number193853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: