Basic Information
Provider Information
NPI: 1003147224
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WRIGHT
FirstName: YVONNE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25650 OUTER DR
Address2: SUITE 401
City: LINCOLN PARK
State: MI
PostalCode: 481462096
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 17200 E 10 MILE RD
Address2: SUITE 165
City: EASTPOINTE
State: MI
PostalCode: 480213355
CountryCode: US
TelephoneNumber: 5865736400
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/28/2010
LastUpdateDate: 01/28/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X5601005639MIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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