Provider Demographics
NPI:1184857872
Name:WRIGHT, MARIE NICHOLE (APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:NICHOLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3250
Mailing Address - Country:US
Mailing Address - Phone:573-450-3977
Mailing Address - Fax:
Practice Address - Street 1:817 S MOUNT AUBURN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6383
Practice Address - Country:US
Practice Address - Phone:573-519-4500
Practice Address - Fax:573-519-4530
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily