Healthcare Provider Details

I. General information

NPI: 1952850406
Provider Name (Legal Business Name): HAYLEY ANN GASSEL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date: 02/10/2024
Reactivation Date: 02/20/2024

III. Provider practice location address

22250 PROVIDENCE DR STE 100
SOUTHFIELD MI
48075-6209
US

IV. Provider business mailing address

19428 GILL RD
LIVONIA MI
48152-1117
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-2710
  • Fax: 248-849-4024
Mailing address:
  • Phone: 734-787-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704311930
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: