Healthcare Provider Details

I. General information

NPI: 1063175024
Provider Name (Legal Business Name): LORNA O'DELL WRIGHT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 FULTON DR NW
CANTON OH
44718-2384
US

IV. Provider business mailing address

4641 FULTON DR NW
CANTON OH
44718-2384
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-6075
  • Fax: 330-494-0299
Mailing address:
  • Phone: 330-433-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0029525
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: