Provider Demographics
NPI:1760546170
Name:WRIGHT, MICHELLE DOREEN (MS, RD, CDE)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:DOREEN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 KNOPF ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1143
Mailing Address - Country:US
Mailing Address - Phone:908-528-6370
Mailing Address - Fax:
Practice Address - Street 1:9100 WESCOTT DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4670
Practice Address - Country:US
Practice Address - Phone:908-237-6920
Practice Address - Fax:908-237-6922
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ953273133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118514Q6EMedicare PIN