Provider Demographics
NPI:1093351397
Name:WRIGHT, LA WANDA
Entity Type:Individual
Prefix:MRS
First Name:LA WANDA
Middle Name:
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 1:10087 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3445
Mailing Address - Country:US
Mailing Address - Phone:540-775-3062
Mailing Address - Fax:540-775-5645
Practice Address - Street 1:10087 KINGS HWY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3445
Practice Address - Country:US
Practice Address - Phone:540-775-3062
Practice Address - Fax:540-775-5645
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator