Provider Demographics
NPI:1508829367
Name:WRIGHT, IRENA ALEXANDRA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:IRENA
Middle Name:ALEXANDRA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 MAIN AVE E
Mailing Address - Street 2:STE 302
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6775
Mailing Address - Country:US
Mailing Address - Phone:253-841-2471
Mailing Address - Fax:253-841-2472
Practice Address - Street 1:1011 E MAIN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6775
Practice Address - Country:US
Practice Address - Phone:253-841-2471
Practice Address - Fax:253-841-2472
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9630880Medicaid
WA9630880Medicaid
G8859158Medicare PIN