Healthcare Provider Details

I. General information

NPI: 1306395330
Provider Name (Legal Business Name): MICHELLE FASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6361 CONIFER DR
YPSILANTI MI
48197-3218
US

IV. Provider business mailing address

6361 CONIFER DR
YPSILANTI MI
48197-3218
US

V. Phone/Fax

Practice location:
  • Phone: 616-881-3858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704276083
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: