Healthcare Provider Details

I. General information

NPI: 1629252580
Provider Name (Legal Business Name): LORI GAYLE WEISC LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI GAYLE PIERCE LPN

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9915 SANDIFUR PKWY
PASCO WA
99301-8941
US

IV. Provider business mailing address

9915 SANDIFUR PKWY
PASCO WA
99301-8941
US

V. Phone/Fax

Practice location:
  • Phone: 509-546-2222
  • Fax: 509-546-2202
Mailing address:
  • Phone: 509-546-2222
  • Fax: 509-546-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberLP00054426
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00054426
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: