Provider Demographics
NPI:1073633079
Name:WRIGHT, STACIE A (CST)
Entity Type:Individual
Prefix:MISS
First Name:STACIE
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 GRAYGATE LN APT E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4057
Mailing Address - Country:US
Mailing Address - Phone:704-552-4807
Mailing Address - Fax:
Practice Address - Street 1:6125 GRAYGATE LN APT E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4057
Practice Address - Country:US
Practice Address - Phone:704-552-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC065214246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist