Individual
DEVON LEE LOSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 HIGH PARK AVE, GOSHEN, IN 46526-4810
(574) 364-2888
Mailing address
200 HIGH PARK AVE, GOSHEN, IN 46526-4810
(574) 364-2888
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002950A
IN
363AM0700X
Medical Physician Assistant
PA00575
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03406312
—
MS
05
—
300038776
—
IN
Enumeration date
05/07/2019
Last updated
07/25/2022
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