=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215977467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARLENE WRIGHT FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 10/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2224 W NORTHERN AVE STE D300
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-277-1449
-----------------------------------------------------
Fax | 602-277-9984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2224 W NORTHERN AVE STE D300
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85021-5099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-277-1449
-----------------------------------------------------
Fax | 602-277-9984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN035478
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------