Provider Demographics
NPI:1538497623
Name:WRIGHT, ALICIA NICHOL (RN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICHOL
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6459 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-7651
Mailing Address - Country:US
Mailing Address - Phone:937-677-8217
Mailing Address - Fax:937-226-1998
Practice Address - Street 1:6459 HOOVER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-7651
Practice Address - Country:US
Practice Address - Phone:937-677-8217
Practice Address - Fax:937-226-1998
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN356010163W00000X
RN356010372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No372600000XNursing Service Related ProvidersAdult Companion