Provider Demographics
NPI:1225371032
Name:CASTELLUZZO, ANISSA (ANP)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:CASTELLUZZO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 S MONROE ST STE C
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1478
Mailing Address - Country:US
Mailing Address - Phone:734-241-0560
Mailing Address - Fax:734-241-3230
Practice Address - Street 1:975 S MONROE ST STE C
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161
Practice Address - Country:US
Practice Address - Phone:734-241-0560
Practice Address - Fax:734-241-3230
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner