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NPI Code Detail

MEDICARE: SHAWN BRICE WRIGHT CRNA

MEDICARE: SHAWN BRICE WRIGHT CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist25345.0913WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003857624
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN BRICE WRIGHT CRNA
Provider Business Mailing Address
First Line : PO BOX 428
Second Line :
City : JACKSON
State : WY
Zip : 83001-0428
Country : US
Telephone Number : 307-739-7218
Fax Number : 307-739-7446
Provider Business Practice Location Address
First Line : 625 E BROADWAY AVE
Second Line :
City : JACKSON
State : WY
Zip : 83001-8642
Country : US
Telephone Number : 307-733-3636
Fax Number : 888-329-5701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 11/16/2015

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