Healthcare Provider Details

I. General information

NPI: 1861022568
Provider Name (Legal Business Name): JACOB ANTHONY LORSUNG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 UNIVERSITY AVE STE B
DUBUQUE IA
52001-4790
US

IV. Provider business mailing address

417 PRIMROSE DR
HUDSON IA
50643-2232
US

V. Phone/Fax

Practice location:
  • Phone: 563-900-8922
  • Fax: 563-279-0653
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number099740
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: