Provider Demographics
NPI:1720632102
Name:PATROSSO, DEANNA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:PATROSSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11081 VARNA ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1447
Mailing Address - Country:US
Mailing Address - Phone:810-247-8954
Mailing Address - Fax:
Practice Address - Street 1:11081 VARNA ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1447
Practice Address - Country:US
Practice Address - Phone:810-247-8954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant