Provider Demographics
NPI:1033636493
Name:FATTIZZO, JOEY (FNP, RN, RDH)
Entity Type:Individual
Prefix:MISS
First Name:JOEY
Middle Name:
Last Name:FATTIZZO
Suffix:
Gender:F
Credentials:FNP, RN, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1804
Mailing Address - Country:US
Mailing Address - Phone:586-615-2568
Mailing Address - Fax:
Practice Address - Street 1:45445 MOUND ROUND
Practice Address - Street 2:SUITE 105
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317
Practice Address - Country:US
Practice Address - Phone:586-200-8707
Practice Address - Fax:248-282-1313
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF08170704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily