Provider Demographics
NPI:1487970091
Name:WRIGHT, MARY COSTELLO (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:COSTELLO
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:710 LAWRENCE EXPY # 190
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:408-851-1141
Mailing Address - Fax:408-851-1199
Practice Address - Street 1:710 LAWRENCE EXPY # 190
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-1141
Practice Address - Fax:408-851-1199
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19296363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics