Provider Demographics
NPI:1962667550
Name:WISDOM, LORI A (NP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:WISDOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6402 LOUETTA RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7582
Mailing Address - Country:US
Mailing Address - Phone:281-251-8700
Mailing Address - Fax:281-251-8701
Practice Address - Street 1:6402 LOUETTA RD STE 140
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7582
Practice Address - Country:US
Practice Address - Phone:281-251-8700
Practice Address - Fax:281-251-8701
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117028363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner