Provider Demographics
NPI:1831911379
Name:LOSSING, EMILY (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LOSSING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DEANN
Other - Last Name:LIDDICOAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7633 E JEFFERSON AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3732
Mailing Address - Country:US
Mailing Address - Phone:313-745-6817
Mailing Address - Fax:313-745-6828
Practice Address - Street 1:7633 E JEFFERSON AVE STE 290
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3732
Practice Address - Country:US
Practice Address - Phone:313-745-6817
Practice Address - Fax:313-745-6828
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012706363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical