MEDICARE: MS. SADE WRIGHT

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	163WR0006X	Registered Nurse First Assistant	00131645	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1306555040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SADE WRIGHT

Provider Business Mailing Address
First Line	:	2624 W MEDFORD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-1027
Country	:	US
Telephone Number	:	414-510-7045
Fax Number	:

Provider Business Practice Location Address
First Line	:	2624 W MEDFORD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-1027
Country	:	US
Telephone Number	:	414-510-7045
Fax Number	:

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

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/22/2022

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