Provider Demographics
NPI:1790057560
Name:WRIGHT, MARY STEPHANIE (APNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:STEPHANIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 EMERALD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53021-9351
Mailing Address - Country:US
Mailing Address - Phone:262-483-4374
Mailing Address - Fax:
Practice Address - Street 1:W3745 NORTH DRIVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073
Practice Address - Country:US
Practice Address - Phone:920-565-1034
Practice Address - Fax:920-272-7846
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4767363L00000X
WI4767-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP01063882OtherRR MEDICARE
WI019940707Medicare PIN
WI462364928Medicare PIN