Provider Demographics
NPI:1811645567
Name:WRIGHT, IRINA M
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:M
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 1:2270 LINDLEY WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3723
Mailing Address - Country:US
Mailing Address - Phone:775-771-4444
Mailing Address - Fax:775-273-2247
Practice Address - Street 1:685 AMHERST AVE
Practice Address - Street 2:
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419-5530
Practice Address - Country:US
Practice Address - Phone:775-273-2246
Practice Address - Fax:775-273-2247
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10486-AGC-0320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities