# JASON MATTHEW FANSLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1659037836
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 71011989A | IN | Yes |
| 363LF0000X | Family Nurse Practitioner | F10210869 | IN | — |

## Other

- **Enumeration date:** 11/12/2021
- **Last updated:** 10/17/2022