Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 47836 | KY |
N | 208600000X | Surgeon | 47836 | KY |
N | 2086S0102X | Surgical Critical Care | 47836 | KY |
Y | 2086S0120X | Pediatric Surgery | 47836 | KY |
NPI | 1992968689 |
---|---|
Provider Name | Dr. Tiffany Nicole Wright |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 11/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300003088 | (05) | IN |
7100354190 | (05) | KY |