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Individual
DR. LORI L WILSON
Active
Individual
DR. LORI L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
SC003555R
PA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC003555R
PA
213ES0131X
Foot Surgery Podiatrist
SC003555R
PA
261QP1100X
Podiatric Clinic/Center
SC003555R
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001214510003
—
PA
Enumeration date
06/20/2005
Last updated
06/16/2018
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