Healthcare Provider Details

I. General information

NPI: 1558152454
Provider Name (Legal Business Name): GISSELLE OSORIO VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E EISENHOWER PKWY
ANN ARBOR MI
48108-3231
US

IV. Provider business mailing address

2334 TWIN LAKES DR
YPSILANTI MI
48197-1493
US

V. Phone/Fax

Practice location:
  • Phone: 734-286-7881
  • Fax:
Mailing address:
  • Phone: 734-286-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: