Individual
MICHELLE BASSIOUNI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4366 PEARSON PKWY, OREGON, OH 43616-3572
(419) 704-9478
Mailing address
4366 PEARSON PKWY, OREGON, OH 43616-3572
(419) 704-9478
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.002160RX
OH
363AM0700X
Medical Physician Assistant
50.002160RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0254822
—
OH
Enumeration date
01/25/2016
Last updated
06/14/2024
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