Provider Demographics
NPI:1205918562
Name:WRIGHT, DIANE (APRN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-5316
Mailing Address - Country:US
Mailing Address - Phone:860-639-3610
Mailing Address - Fax:
Practice Address - Street 1:932 BANK ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-437-2383
Practice Address - Fax:860-437-2388
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001131363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
04178746CLOtherCLINIC
CT4014679Medicaid
CT4024972Medicaid
114025OtherVALUE OPTIONS
CT4014679Medicaid
S93876Medicare UPIN