Provider Demographics
NPI:1760848634
Name:LOZON, TRICIA IRENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:IRENE
Last Name:LOZON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:IRENE
Other - Last Name:VELTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5800 FOREMOST DR SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7062
Mailing Address - Country:US
Mailing Address - Phone:616-954-9800
Mailing Address - Fax:
Practice Address - Street 1:250 CHERRY ST SE STE 2200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4608
Practice Address - Country:US
Practice Address - Phone:616-685-5600
Practice Address - Fax:616-685-6745
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant