Provider Demographics
NPI:1528683976
Name:WRIGHT, MARIE GAGNE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:GAGNE
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 1:244 E CARIBBEAN DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5071
Mailing Address - Country:US
Mailing Address - Phone:520-705-8714
Mailing Address - Fax:
Practice Address - Street 1:958 E RODEO RD STE 21
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6455
Practice Address - Country:US
Practice Address - Phone:520-214-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV25461175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath