Provider Demographics
NPI:1417970682
Name:WILSON, LORI B (RM)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:B
Last Name:WILSON
Suffix:
Gender:F
Credentials:RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4008
Mailing Address - Country:US
Mailing Address - Phone:719-460-6463
Mailing Address - Fax:
Practice Address - Street 1:2211 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6946
Practice Address - Country:US
Practice Address - Phone:719-460-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO58175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay