Provider Demographics
NPI:1679345672
Name:WRIGHTNER, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:WRIGHTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3040 FRUIT ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:MI
Practice Address - Zip Code:48001-4802
Practice Address - Country:US
Practice Address - Phone:810-543-5596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703113267164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse