Basic Information
| Provider Information | |||||||||
| NPI: | 1043248933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOSINGER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LOU | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 HOFFMAN ST | ||||||||
| Address2: | |||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 149052263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077342264 | ||||||||
| FaxNumber: | 6077670340 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 HOFFMAN ST | ||||||||
| Address2: | |||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 149052263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077342264 | ||||||||
| FaxNumber: | 6077670340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 330213 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 161355553 | 01 | BUSINESS TAX ID | OTHER | 01267812 | 05 | NY | MEDICAID |