Individual
MARILYN LOUISE VANTASSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
3150 LIVERNOIS RD, SUITE 170, TROY, MI 48083-5031
(888) 315-5442
Mailing address
3150 LIVERNOIS RD, SUITE 170, TROY, MI 48083-5031
(888) 315-5442
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4704125395
MI
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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