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Individual

JESSICA WRIGHT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
HWY 264 MILEPOST 388, POLACCA, AZ 86042-4000
(928) 737-6000
Mailing address
PO BOX 1064, KEAMS CANYON, AZ 86034-1064

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001218112
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
020529
AZ
Enumeration date
09/08/2014
Last updated
09/08/2014
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