Basic Information
Provider Information | |||||||||
NPI: | 1295069474 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WRIGHT | ||||||||
FirstName: | JUDITH | ||||||||
MiddleName: | K | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 41 UNIVERSITY DR | ||||||||
Address2: | SUITE 300 | ||||||||
City: | NEWTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 189401873 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2157105522 | ||||||||
FaxNumber: | 2157105181 | ||||||||
Practice Location | |||||||||
Address1: | 1203 LANGHORNE NEWTOWN RD | ||||||||
Address2: | SUITE 320 | ||||||||
City: | LANGHORNE | ||||||||
State: | PA | ||||||||
PostalCode: | 19047 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2157507818 | ||||||||
FaxNumber: | 2157520436 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/22/2009 | ||||||||
LastUpdateDate: | 05/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | SP010431 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
ID | Type | State | Issuer | Description | 3114480 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 4558376 | 01 | PA | CIGNA PA | OTHER | P01417919 | 01 | PA | RAILROAD MEDICARE | OTHER | 1029930830001 | 05 | PA |   | MEDICAID | 30231907 | 01 | PA | KEYSTONE FIRST | OTHER | 4188361 | 01 | PA | AETNA | OTHER |