Healthcare Provider Details

I. General information

NPI: 1356649099
Provider Name (Legal Business Name): LORI BIESECKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 OAKWOOD HILLS PKWY
EAU CLAIRE WI
54701-7698
US

IV. Provider business mailing address

3440 OAKWOOD HILLS PKWY
EAU CLAIRE WI
54701-7698
US

V. Phone/Fax

Practice location:
  • Phone: 715-214-2525
  • Fax:
Mailing address:
  • Phone: 715-214-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number107540-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: