Provider Demographics
NPI:1578598652
Name:WRIGHT, RICHELE L (NP)
Entity type:Individual
Prefix:
First Name:RICHELE
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:492 S BIERMA ST
Practice Address - Street 2:
Practice Address - City:WHEATFIELD
Practice Address - State:IN
Practice Address - Zip Code:46392-6004
Practice Address - Country:US
Practice Address - Phone:219-956-2110
Practice Address - Fax:219-956-3548
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209005929363L00000X
IN71011156A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicare UPIN