Provider Demographics
NPI:1700894888
Name:WRIGHT, WILMA J
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WILMA
Other - Middle Name:J
Other - Last Name:WRIGHT-EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6306 IRONSIDE DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4474
Mailing Address - Country:US
Mailing Address - Phone:904-908-6048
Mailing Address - Fax:
Practice Address - Street 1:6306 IRONSIDE DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4474
Practice Address - Country:US
Practice Address - Phone:904-908-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL84620376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide