Individual
HEATHER GASSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6198 WINCLIFF DR, WEST BLOOMFIELD, MI 48322-2099
(248) 914-9992
Mailing address
PO BOX 675133, DETROIT, MI 48267-5133
(313) 561-6420
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704313791
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704313791
LICENSE
MI
Enumeration date
04/16/2021
Last updated
04/16/2021
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