MEDICARE: WADE MILTON 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1467038083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WADE MILTON WRIGHT

Provider Business Mailing Address
First Line	:	3017 W MOHAWK LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3116
Country	:	US
Telephone Number	:	623-980-5786
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 W SACK DR STE 302
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7107
Country	:	US
Telephone Number	:	623-561-7983
Fax Number	:

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/23/2021

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Directions to “ WADE MILTON WRIGHT ” Practice Location

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