Provider Demographics
NPI:1437286523
Name:WRIGHT, REBECCA GUSMUS (CPNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GUSMUS
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:GUSMUS
Other - Last Name:WRIGHT- BOWDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP
Mailing Address - Street 1:86 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-3845
Mailing Address - Country:US
Mailing Address - Phone:804-435-2651
Mailing Address - Fax:804-435-2302
Practice Address - Street 1:86 HARRIS RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3845
Practice Address - Country:US
Practice Address - Phone:804-435-2651
Practice Address - Fax:804-435-2302
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024096876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05381OtherGROUP PTAN