MEDICARE: MR. JAREN PHILIP WRIGHT RN

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
1	251S00000X	Community/Behavioral Health Agency	239021	AZ

General Provider Information

NPI Number	:	1245073709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAREN PHILIP WRIGHT RN

Provider Business Mailing Address
First Line	:	1555 S GILBERT RD STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6000
Country	:	US
Telephone Number	:	480-253-9356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 S GILBERT RD STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6000
Country	:	US
Telephone Number	:	480-253-9356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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