Provider Demographics
NPI:1164272001
Name:CASSETTE, MARY MICHELLE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELLE
Last Name:CASSETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21650 TULIPWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1520
Mailing Address - Country:US
Mailing Address - Phone:734-674-2191
Mailing Address - Fax:
Practice Address - Street 1:21650 TULIPWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1520
Practice Address - Country:US
Practice Address - Phone:734-674-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker