Provider Demographics
NPI:1861482648
Name:WRIGHT, SANDRA L (NP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 N WABASH
Mailing Address - Street 2:STE G20
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7600
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:4781 KAYBEE DR
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-6607
Practice Address - Country:US
Practice Address - Phone:765-660-7840
Practice Address - Fax:765-671-3509
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001813A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200528190Medicaid
000000769561OtherANTHEM
Q42167Medicare UPIN
000000769561OtherANTHEM