Provider Demographics
NPI:1629252580
Name:WEISC, LORI GAYLE (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:GAYLE
Last Name:WEISC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:GAYLE
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:9915 SANDIFUR PKWY
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8941
Mailing Address - Country:US
Mailing Address - Phone:509-546-2222
Mailing Address - Fax:509-546-2202
Practice Address - Street 1:9915 SANDIFUR PKWY
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8941
Practice Address - Country:US
Practice Address - Phone:509-546-2222
Practice Address - Fax:509-546-2202
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00054426163WX0106X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALP00054426OtherLICENSE