Provider Demographics
NPI:1427663855
Name:WRIGHT, CONNIE SUE
Entity type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:SUE
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 1:6245 COX RD.
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-1509
Mailing Address - Country:US
Mailing Address - Phone:330-673-2819
Mailing Address - Fax:
Practice Address - Street 1:6245 COX RD.
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-1509
Practice Address - Country:US
Practice Address - Phone:330-673-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide