Provider Demographics
NPI:1528172194
Name:WRIGHT, ILEEN MARIE (APRN, BC)
Entity type:Individual
Prefix:
First Name:ILEEN
Middle Name:MARIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S BARRINGTON AVE
Mailing Address - Street 2:#402
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6436
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:
Practice Address - Street 1:VA GLA HEALTHCARE SYSTEM 11301 WILSHIRE BLVD.
Practice Address - Street 2:11301 WILSHIRE BLVD.
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24163WA0400X
MO058907364S00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist