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NPI Code Detail

MEDICARE: LORI ELLA WYSONG CPNP-PC

MEDICARE: LORI ELLA WYSONG CPNP-PC
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
1363LP0200XPediatric Nurse Practitioner209028816IL
2363LP0200XPediatric Nurse Practitioner309021005IL
3363LP0200XPediatric Nurse Practitioner7027WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881046324
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI ELLA WYSONG CPNP-PC
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 10400 75TH ST STE 301
Second Line :
City : KENOSHA
State : WI
Zip : 53142-7884
Country : US
Telephone Number : 262-948-6798
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2016
Last Update Date : 01/06/2026

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