Provider Demographics
NPI:1821228610
Name:WIESER, LORI BETH (ND)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:BETH
Last Name:WIESER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 13263
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-0200
Mailing Address - Country:US
Mailing Address - Phone:360-402-4943
Mailing Address - Fax:360-357-5946
Practice Address - Street 1:3015 LIMITED LN STE A2
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2638
Practice Address - Country:US
Practice Address - Phone:360-402-4943
Practice Address - Fax:360-357-5946
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603469377175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath