Individual
LORI ELLA WYSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
10400 75TH ST STE 301, KENOSHA, WI 53142-7884
(262) 948-6798
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209028816
IL
363LP0200X
Pediatric Nurse Practitioner
309021005
IL
363LP0200X
Pediatric Nurse Practitioner
7027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100058512
—
WI
05
—
1881046324
—
IL
05
—
1881046324
—
WI
Enumeration date
07/08/2016
Last updated
01/06/2026
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