Provider Demographics
NPI:1508044033
Name:WRIGHT, ANTOINETTE T (LMP)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:T
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36915 5TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-7346
Mailing Address - Country:US
Mailing Address - Phone:253-797-4567
Mailing Address - Fax:
Practice Address - Street 1:204 S 348TH ST
Practice Address - Street 2:STE 3
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7041
Practice Address - Country:US
Practice Address - Phone:253-797-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024495174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist