MEDICARE: LORI JEAN WAIN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP015293	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	13613611	OTHER	PA	CAQH

General Provider Information

NPI Number	:	1235507377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI JEAN WAIN CRNP

Provider Business Mailing Address
First Line	:	107 MOUNT NEBO PTE STE 101
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-1316
Country	:	US
Telephone Number	:	412-548-1090
Fax Number	:	125-483-1234

Provider Business Practice Location Address
First Line	:	107 MOUNT NEBO POINTE RD STE 101
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-1316
Country	:	US
Telephone Number	:	412-548-1090
Fax Number	:	412-548-3123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2015
Last Update Date	:	09/10/2018

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