Provider Demographics
NPI:1679063218
Name:WRIGHT, CHANEL NADJA (FNP)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:NADJA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:LONG POND
Mailing Address - State:PA
Mailing Address - Zip Code:18334-7824
Mailing Address - Country:US
Mailing Address - Phone:570-460-3370
Mailing Address - Fax:
Practice Address - Street 1:152 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:LONG POND
Practice Address - State:PA
Practice Address - Zip Code:18334-7824
Practice Address - Country:US
Practice Address - Phone:570-460-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily