Provider Demographics
NPI:1558989186
Name:WRIGHT, OLIVIA BROOKE (NP)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:BROOKE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 MIDTOWN AVE APT 1317
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1437
Mailing Address - Country:US
Mailing Address - Phone:740-361-8212
Mailing Address - Fax:
Practice Address - Street 1:2451 MIDTOWN AVE APT 1317
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1437
Practice Address - Country:US
Practice Address - Phone:740-361-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179653363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024179653OtherLICENSE NO.