Provider Demographics
NPI:1598313637
Name:WRIGHT, SANDRA (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 PENSHURST LN APT 204
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6350
Mailing Address - Country:US
Mailing Address - Phone:734-834-4061
Mailing Address - Fax:
Practice Address - Street 1:14165 N FENTON RD STE 201A
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1584
Practice Address - Country:US
Practice Address - Phone:810-853-5875
Practice Address - Fax:586-279-4515
Is Sole Proprietor?:No
Enumeration Date:2019-09-02
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178127363LA2200X
MI4704272415207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health