Basic Information
| Provider Information | |||||||||
| NPI: | 1376879718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | JUANITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 PINE ROCK RD | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065111664 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 226 DIXWELL AVE | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065113456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035033205 | ||||||||
| FaxNumber: | 2035033455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2009 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA2000X | E48890 | CT | Y | Nursing Service Providers | Registered Nurse | Administrator |
ID Information
| ID | Type | State | Issuer | Description | 004235900 | 05 | CT | MEDICAID |