Provider Demographics
NPI:1982904876
Name:VICSEK, LORI ANN (FNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:VICSEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3028
Mailing Address - Country:US
Mailing Address - Phone:903-872-2151
Mailing Address - Fax:903-872-0126
Practice Address - Street 1:618 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3028
Practice Address - Country:US
Practice Address - Phone:903-872-2151
Practice Address - Fax:903-872-0126
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX773080363LF0000X
TXAP119664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily