Provider Demographics
NPI:1447998760
Name:VASSALLO, ADRIENNE FASBINDER (MSN, APRN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:FASBINDER
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:LEE
Other - Last Name:FASBINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32270 TELEGRAPH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2456
Mailing Address - Country:US
Mailing Address - Phone:248-792-9496
Mailing Address - Fax:
Practice Address - Street 1:32270 TELEGRAPH RD STE 110
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-792-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704327435363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty