Individual
TIMOTHY ROBERT LA GASSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
401 CONNABLE AVE, PETOSKEY, MI 49770
(231) 487-4520
Mailing address
PO BOX 185, WALLOON LAKE, MI 49796-0185
(231) 535-6067
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704249602
MI
Other
Enumeration date
01/10/2018
Last updated
01/10/2018
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