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Individual

JACLYN LOSTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
15125 22 MILE RD, SHELBY TWP, MI 48315-4406
(586) 532-0599
Mailing address
2922 BIRCHENA CRES, WEST BLOOMFIELD, MI 48324-2104

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704285720
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1669993168
PRESCRIBER
MI
Enumeration date
07/05/2017
Last updated
01/26/2022
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