Individual
TATYANA FASTOVSKAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12760 W 87TH STREET PKWY, LENEXA, KS 66215-4635
(816) 668-8977
Mailing address
12760 W 87TH STREET PKWY, LENEXA, KS 66215-4635
(816) 668-8977
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/22/2012
Last updated
04/30/2020
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