Healthcare Provider Details

I. General information

NPI: 1336601673
Provider Name (Legal Business Name): JOYSETTE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 CORAL ST
PHILADELPHIA PA
19134-3725
US

IV. Provider business mailing address

3066 CORAL ST
PHILADELPHIA PA
19134-3725
US

V. Phone/Fax

Practice location:
  • Phone: 215-245-2131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN029167
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: