PATRICIA VASSALLO (NPI# 1194122937) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194122937 |
| Entity Type | Individual |
| Full Name | PATRICIA VASSALLO |
| Credential | CPNP |
| Practice Address |
22151 Moross Rd Pb 2 Suite 209 Detroit MI 48236-2167 |
| Mailing Address |
22151 Moross Professional Building 1 Suite 209 Detroit MI 48236 |
| Practice Telephone | 3133433978 |
| Practice Fax Number | 3134172730 |
| Mailing Telephone | 3133433978 |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2015-02-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
4704268599 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS | 0H208910 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205053998 | Patricia Vassallo | Internal Medicine | 675 N Saint Clair St Ste 1900, Chicago, IL 60611-5975 | 2007-04-20 |
| Street Address |
22151 MOROSS RD PB 2 SUITE 209 |
| City | DETROIT |
| State | MI |
| Zip Code | 48236-2167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366440463 | Christine Ann Crader | Internal Medicine | 22151 Moross Rd, Detroit, MI 48236-2167 | 2005-07-12 |
| 1467078857 | Anirudh Kotha | Student in an Organized Health Care Education/Training Program | 22151 Moross Rd, Ste 214, Detroit, MI 48236 | 2020-06-22 |
| 1386147981 | Carla Freigeh | Physician Assistant | 22151 Moross Rd, Detroit, MI 48236-2167 | 2018-03-10 |
| 1245738822 | Stacey Alise Joiner | Counselor | 22151 Moross Rd, Detroit, MI 48236-2167 | 2018-01-29 |
| 1730618158 | Victoria Elizabeth Simmons | Surgery | 22151 Moross Rd, Suite 214, Detroit, MI 48236 | 2017-06-08 |
| 1902356272 | Jisha Dudeesh | Nurse Practitioner | 22151 Moross Rd, Professional Building One, Detroit, MI 48236-2167 | 2016-10-10 |
| 1841740792 | Celia Shallal | Social Worker | 22151 Moross Rd, Pb1, Detroit, MI 48236-2167 | 2016-10-04 |
| 1841668308 | Moayad Tarboush | Student in an Organized Health Care Education/Training Program | 22151 Moross Rd, Detroit, MI 48236-2167 | 2015-09-14 |
| 1285023226 | Lauren Krist | Nurse Practitioner | 22151 Moross Rd, Detroit, MI 48236-2167 | 2015-01-14 |
| 1861736431 | Amer Abdul-hafiz Afaneh | Surgery | 22151 Moross Rd, Suite 212, Detroit, MI 48236-2167 | 2012-11-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
| Find all providers in zip 48236 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376913822 | Michael J. Mooney | Nurse Practitioner | 3901 Beaubien, 3rd Floor Carl's Bldg,, #3g32, Children's Hospital of Mi, Detroit, MI 48201-2153 | 2015-09-28 |
| 1295079895 | Mia Love | Nurse Practitioner | 2959 Martin Luther King Jr Blvd, Detroit, MI 48208 | 2012-11-20 |
| 1164773099 | Fatima Mays | Nurse Practitioner | 5020 Cadieux, Detroit, MI 48224-2153 | 2012-10-02 |
| 1891027173 | Ruth Alma Roeder | Nurse Practitioner | 3901 Beaubien 3rd Floor Main Bldg, Children's Hospital of Mi, Detroit, MI 48201 | 2010-02-11 |
| 1265584171 | April K Morris | Nurse Practitioner | 3901 Beaubien - Er Dept, Children's Hospital of Mi, Detroit, MI 48201 | 2007-01-18 |
| 1336299767 | Patricia Sue Beierwaltes | Nurse Practitioner | Children's Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI 48201 | 2007-01-10 |
| 1508921388 | Tina Marcia Almanza | Nurse Practitioner | 1903 Wilkins St, Detroit, MI 48207-2112 | 2006-12-22 |
| 1871656629 | Sylvia Lou Smith | Nurse Practitioner | 8820 Woodrow Wilson St, Hutchins Health Center (henry Ford Health System), Detroit, MI 48206-2216 | 2006-12-19 |
| 1194762195 | Heather L Bartlett | Nurse Practitioner | 3950 Beaubien, Childrens Hospital of Mi, Detroit, MI 48201 | 2006-05-31 |
| 1033188099 | Cathy Patty-resk | Nurse Practitioner | Children's Hospital of Mi, 3950 Beaubien, Detroit, MI 48201 | 2006-03-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.