Provider Demographics
NPI:1851402713
Name:MEASEL, AMY JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:MEASEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JEAN
Other - Last Name:LORKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 675398
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-5398
Mailing Address - Country:US
Mailing Address - Phone:586-329-1880
Mailing Address - Fax:586-231-0055
Practice Address - Street 1:133 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2308
Practice Address - Country:US
Practice Address - Phone:586-468-1600
Practice Address - Fax:586-465-0329
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004757363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315095227OtherCONTROLLED SUBSTANCE LICENSE
MI5601004757OtherPHYSICIAN ASSISTANT LICENSE
MIML1625257OtherDEA