Healthcare Provider Details

I. General information

NPI: 1205282951
Provider Name (Legal Business Name): MEGHAN ALYSSA LAROSE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGHAN ALYSSA EDWARDS

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 E WALTON BLVD
AUBURN HILLS MI
48326-2370
US

IV. Provider business mailing address

3095 E WALTON BLVD
AUBURN HILLS MI
48326-2370
US

V. Phone/Fax

Practice location:
  • Phone: 248-373-1790
  • Fax:
Mailing address:
  • Phone: 248-373-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013571
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: