Provider Demographics
NPI:1184887929
Name:WRIGHT, DARRALYN DELLICE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DARRALYN
Middle Name:DELLICE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DARRALYN
Other - Middle Name:DELLICE
Other - Last Name:BOHANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:87 PAXTON AVE
Mailing Address - Street 2:APT.3N
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-1557
Mailing Address - Country:US
Mailing Address - Phone:708-566-0324
Mailing Address - Fax:
Practice Address - Street 1:87 PAXTON AVE
Practice Address - Street 2:APT.3N
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-1557
Practice Address - Country:US
Practice Address - Phone:708-566-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN101904164W00000X
IN27070140A164W00000X
IL043080115164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2686473Medicaid