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General NPI Number Information
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NPI Number | 1275921629
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Entity Type | Individual
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Provider Name | BREANNE TERESA PASSALACQUA M.A.,TLLP
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Gender | Female
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 4400 S SAGINAW ST SUIT 1460
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City | FLINT
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State | MI
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Zip | 48507-2645
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Country | US
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Telephone | 810-237-0799
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Fax |
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Provider Business Mailing Address
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Address Line | 10291 FOLEY RD
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City | FENTON
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State | MI
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Zip | 48430-9250
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Country | US
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Telephone | 810-597-7293
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 6301016145
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License Number State | MI
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