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NPI Code Detail

MEDICARE: MRS. ELIZABETH ANNE VASSALLO CNP

MEDICARE:  MRS. ELIZABETH ANNE VASSALLO  CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner8208MN

General Provider Information

NPI Number : 1073189759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH ANNE VASSALLO CNP
Provider Business Mailing Address
First Line : 2466 FIELDSTONE RD SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55902-1378
Country : US
Telephone Number : 507-884-1984
Fax Number :
Provider Business Practice Location Address
First Line : 2110 E CENTER ST
Second Line :
City : ROCHESTER
State : MN
Zip : 55904-4754
Country : US
Telephone Number : 507-287-0674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2021
Last Update Date : 03/27/2026

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