Individual
LORI TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1316 N 14TH ST, SUPERIOR, WI 54880-1773
(715) 395-1246
Mailing address
1712 CUMMING AVE, SUPERIOR, WI 54880-2736
(307) 394-1358
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
330783-31
WI
Other
Enumeration date
10/05/2023
Last updated
10/05/2023
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