Individual
PATRICIA VASSALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
22151 MOROSS RD, PB 2 SUITE 209, DETROIT, MI 48236-2167
(313) 343-3978
(313) 417-2730
Mailing address
48353 COMMONVIEW DR, SHELBY TWP, MI 48317-2772
(248) 961-4371
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
4704268599
MI
363LP0200X
Pediatric Nurse Practitioner
71016443A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
SP027691
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H208910
BLUE CROSS
MI
Enumeration date
11/21/2014
Last updated
04/23/2025
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