Provider Demographics
NPI:1649628231
Name:YASSO-VANDER VLIET, DEANA (FNP-BC)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:YASSO-VANDER VLIET
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:
Other - Last Name:YASSO-VANDER VLIET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2421 MONROE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3043
Mailing Address - Country:US
Mailing Address - Phone:313-562-4100
Mailing Address - Fax:
Practice Address - Street 1:2421 MONROE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3043
Practice Address - Country:US
Practice Address - Phone:313-562-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily