Provider Demographics
NPI:1063541555
Name:WRIGHT, JOANNE F (LMP)
Entity type:Individual
Prefix:MISS
First Name:JOANNE
Middle Name:F
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:JOANNE
Other - Middle Name:F
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0578
Mailing Address - Country:US
Mailing Address - Phone:360-731-3151
Mailing Address - Fax:
Practice Address - Street 1:1008 BETHEL AVE STE A
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4236
Practice Address - Country:US
Practice Address - Phone:360-895-7744
Practice Address - Fax:360-895-1166
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004548208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6012482931DMedicare UPIN