Provider Demographics
NPI:1578064598
Name:WRIGHT, ALICIA REBECCA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:REBECCA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 FALLSTAFF MANOR CT APT I
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2826
Mailing Address - Country:US
Mailing Address - Phone:443-314-9288
Mailing Address - Fax:
Practice Address - Street 1:3004 FALLSTAFF MANOR CT APT I
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2826
Practice Address - Country:US
Practice Address - Phone:443-314-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW18606913253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care