Provider Demographics
NPI:1891170007
Name:WRIGHT, ELLA M (NP)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELLA
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:960 DANTZLER ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4322
Mailing Address - Country:US
Mailing Address - Phone:803-937-5823
Mailing Address - Fax:803-747-7297
Practice Address - Street 1:960 DANTZLER ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4322
Practice Address - Country:US
Practice Address - Phone:803-937-5823
Practice Address - Fax:803-747-7297
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPENDINGMedicaid