Healthcare Provider Details

I. General information

NPI: 1073189759
Provider Name (Legal Business Name): ELIZABETH ANNE VASSALLO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANNE CLAYPOOL

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E CENTER ST
ROCHESTER MN
55904-4754
US

IV. Provider business mailing address

2466 FIELDSTONE RD SW
ROCHESTER MN
55902-1378
US

V. Phone/Fax

Practice location:
  • Phone: 507-287-0674
  • Fax:
Mailing address:
  • Phone: 507-884-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8208
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: