Provider Demographics
NPI:1760922587
Name:WRIGHT, GRACE FLORA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:FLORA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-0011
Mailing Address - Country:US
Mailing Address - Phone:503-381-1765
Mailing Address - Fax:971-242-4109
Practice Address - Street 1:702 JOHN ADAMS ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1955
Practice Address - Country:US
Practice Address - Phone:503-381-1765
Practice Address - Fax:971-242-4109
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC180729171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist