Provider Demographics
NPI:1740937259
Name:WISHART, LORIEANN ROSE
Entity type:Individual
Prefix:
First Name:LORIEANN
Middle Name:ROSE
Last Name:WISHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WISHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-0496
Mailing Address - Country:US
Mailing Address - Phone:701-339-0303
Mailing Address - Fax:
Practice Address - Street 1:611 2ND ST. S.E.
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730
Practice Address - Country:US
Practice Address - Phone:701-339-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant