Provider Demographics
NPI:1356649099
Name:BIESECKER, LORI (RN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BIESECKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 OAKWOOD HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7698
Mailing Address - Country:US
Mailing Address - Phone:715-214-2525
Mailing Address - Fax:
Practice Address - Street 1:3440 OAKWOOD HILLS PKWY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7698
Practice Address - Country:US
Practice Address - Phone:715-214-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI107540-30163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)