Healthcare Provider Details

I. General information

NPI: 1346063039
Provider Name (Legal Business Name): TERESA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 SW VETERANS HOSPITAL RD
PORTLAND OR
97239-3076
US

IV. Provider business mailing address

3416 NE 61ST AVE
PORTLAND OR
97213-3936
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number201390029RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number201390029RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: