Provider Demographics
NPI:1447070230
Name:WRIGHT, VONTISHA LYNN
Entity type:Individual
Prefix:
First Name:VONTISHA
Middle Name:LYNN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MATHEWS RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3079
Mailing Address - Country:US
Mailing Address - Phone:330-834-5007
Mailing Address - Fax:
Practice Address - Street 1:366 MATHEWS RD UNIT A
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3079
Practice Address - Country:US
Practice Address - Phone:330-834-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker