Provider Demographics
NPI:1427036789
Name:ERDMAN, LORI K (ANPC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:K
Last Name:ERDMAN
Suffix:
Gender:F
Credentials:ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WIND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-847-2611
Mailing Address - Fax:715-847-2465
Practice Address - Street 1:500 WIND RIDGE DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-847-2611
Practice Address - Fax:715-847-2465
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI813-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43847000Medicaid
S48432Medicare UPIN