Provider Demographics
NPI:1770337149
Name:WRIGHT, DANA RICKS (LVN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:RICKS
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELE
Other - Last Name:RICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:3441 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8161
Mailing Address - Country:US
Mailing Address - Phone:469-955-2055
Mailing Address - Fax:
Practice Address - Street 1:3441 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8161
Practice Address - Country:US
Practice Address - Phone:469-955-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211338164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse