MEDICARE: DR. LAUREEN WISHOM CDP

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1881118529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREEN WISHOM CDP

Provider Business Mailing Address
First Line	:	1623 ROCKIN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-3832
Country	:	US
Telephone Number	:	281-584-0348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 ROCKIN DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-3832
Country	:	US
Telephone Number	:	281-584-0348
Fax Number	:

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

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	07/21/2022

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Directions to “ DR. LAUREEN WISHOM CDP” Practice Location

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