Provider Demographics
NPI:1245795368
Name:WRIGHT, ERICA JO (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:JO
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10542 W STONECROP DR
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5502
Mailing Address - Country:US
Mailing Address - Phone:208-830-1368
Mailing Address - Fax:
Practice Address - Street 1:10542 W STONECROP DR
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5502
Practice Address - Country:US
Practice Address - Phone:208-830-1368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty