Provider Demographics
NPI:1184243826
Name:WRIGHT, DESIRA
Entity type:Individual
Prefix:
First Name:DESIRA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 OLD TERRITORIAL RD NE APT 4
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923-1610
Mailing Address - Country:US
Mailing Address - Phone:507-436-4816
Mailing Address - Fax:
Practice Address - Street 1:320 OLD TERRITORIAL RD NE APT 4
Practice Address - Street 2:
Practice Address - City:CHATFIELD
Practice Address - State:MN
Practice Address - Zip Code:55923-1610
Practice Address - Country:US
Practice Address - Phone:507-436-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other