Provider Demographics
NPI:1134126055
Name:WRIGHT, PAULETTE DIANA I (RN FNP-C/PA)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:DIANA
Last Name:WRIGHT
Suffix:I
Gender:F
Credentials:RN FNP-C/PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 W INDIAN SCHOOL RD STE 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-2980
Mailing Address - Country:US
Mailing Address - Phone:623-247-2300
Mailing Address - Fax:623-247-1939
Practice Address - Street 1:8260 W INDIAN SCHOOL RD STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-2980
Practice Address - Country:US
Practice Address - Phone:623-247-2300
Practice Address - Fax:623-247-1939
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-07-02
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
AZ124982363LF0000X
CA295086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ124982OtherREGISTERED NURSE LICENSE
AZ202850015OtherTAX ID
CA295086OtherREGISTERED NURSE LICENS
AZ421591322OtherTAX ID NUMBER
AZ421591322OtherTAX ID NUMBER