Provider Demographics
NPI:1194825612
Name:WRIGHT, LEO B (CRNA)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:B
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:250 NE MULBERRY ST
Mailing Address - Street 2:SJS MEDICAL MANAGEMENT, STE 202
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4533
Mailing Address - Country:US
Mailing Address - Phone:816-389-4130
Mailing Address - Fax:816-389-4140
Practice Address - Street 1:250 NE MULBERRY ST
Practice Address - Street 2:SJS MEDICAL MANAGEMENT, STE 202
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4533
Practice Address - Country:US
Practice Address - Phone:816-389-4130
Practice Address - Fax:816-389-4140
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2008-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO109740367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOJ110649Medicare PIN
MOP00112955Medicare PIN