Provider Demographics
NPI:1235507377
Name:WAIN, LORI JEAN (CRNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:WAIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JEAN
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:107 MOUNT NEBO PTE STE 101
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-1316
Mailing Address - Country:US
Mailing Address - Phone:412-548-1090
Mailing Address - Fax:125-483-1234
Practice Address - Street 1:107 MOUNT NEBO POINTE RD STE 101
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-1316
Practice Address - Country:US
Practice Address - Phone:412-548-1090
Practice Address - Fax:412-548-3123
Is Sole Proprietor?:No
Enumeration Date:2015-09-06
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032706840001Medicaid
PA13613611OtherCAQH