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General NPI Number Information
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NPI Number | 1013424191
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Entity Type | Individual
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Provider Name | TIMOTHY ROBERT LA GASSE NP
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Gender | Male
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 401 CONNABLE AVE
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City | PETOSKEY
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State | MI
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Zip | 49770
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Country | US
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Telephone | 231-487-4520
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 185
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City | WALLOON LAKE
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State | MI
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Zip | 49796-0185
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Country | US
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Telephone | 231-535-6067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704249602
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License Number State | MI
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