Provider Demographics
NPI:1760718522
Name:WRIGHT TAPPLIN, LADONNA KAY (BACHELOR)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:KAY
Last Name:WRIGHT TAPPLIN
Suffix:
Gender:F
Credentials:BACHELOR
Other - Prefix:
Other - First Name:LA DONNA
Other - Middle Name:KAY
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2013 ROYAL GARDENS PL
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3155
Mailing Address - Country:US
Mailing Address - Phone:702-630-2407
Mailing Address - Fax:
Practice Address - Street 1:2013 ROYAL GARDEN PLACE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084
Practice Address - Country:US
Practice Address - Phone:702-630-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760718522Medicaid