Provider Demographics
NPI:1003432782
Name:WRIGHT, JAYDE M (LPN)
Entity Type:Individual
Prefix:
First Name:JAYDE
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-1309
Mailing Address - Country:US
Mailing Address - Phone:360-843-8235
Mailing Address - Fax:
Practice Address - Street 1:638 12TH ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-1309
Practice Address - Country:US
Practice Address - Phone:360-843-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60968938164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse