Healthcare Provider Details

I. General information

NPI: 1669265930
Provider Name (Legal Business Name): JANIELLE LOSAW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TELEGRAPH RD
PONTIAC MI
48341-1032
US

IV. Provider business mailing address

233 LINDEN AVE
ROYAL OAK MI
48073-3470
US

V. Phone/Fax

Practice location:
  • Phone: 800-231-1127
  • Fax:
Mailing address:
  • Phone: 503-928-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704384887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: