Healthcare Provider Details

I. General information

NPI: 1689581134
Provider Name (Legal Business Name): KASEY TASSELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASEY HIMMELEIN RN

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 ROMENCE RD STE 105
PORTAGE MI
49024-3437
US

IV. Provider business mailing address

6516 SUSSEX ST
PORTAGE MI
49024-8921
US

V. Phone/Fax

Practice location:
  • Phone: 269-459-6010
  • Fax:
Mailing address:
  • Phone: 269-532-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704414897
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: