Individual
MISS JACQUELINE RENEE LASSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4160 JOHN R ST STE 615, DETROIT, MI 48201-2022
(313) 745-5111
(313) 993-8669
Mailing address
4160 JOHN R ST STE 615, DETROIT, MI 48201-2022
(313) 745-5111
(313) 993-8669
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005878
MI
363AS0400X
Surgical Physician Assistant
5601005878
MI
Other
Enumeration date
09/23/2010
Last updated
11/20/2024
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