Provider Demographics
NPI:1164037628
Name:WRIGHT, ROXIE LYNN
Entity Type:Individual
Prefix:
First Name:ROXIE
Middle Name:LYNN
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 1:220 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1035
Mailing Address - Country:US
Mailing Address - Phone:740-491-7158
Mailing Address - Fax:
Practice Address - Street 1:90477 MILLER STATION RD
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:OH
Practice Address - Zip Code:43976-9725
Practice Address - Country:US
Practice Address - Phone:740-946-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101817Medicaid