Individual
LORI ANNE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
4348 ELECTRIC RD, ROANOKE, VA 24018-0720
(540) 769-0976
(540) 857-5386
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5715
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024178297
VA
363LP0200X
Pediatric Nurse Practitioner
17778
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2014
—
SC
Enumeration date
10/12/2006
Last updated
08/08/2022
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