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MR. JONATHAN MICHAEL FANSLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
2500 N DETROIT ST, LAGRANGE, IN 46761-1158
(260) 463-2133
(260) 463-3775
Mailing address
PO BOX 236, LAGRANGE, IN 46761-0236
(260) 463-2133
(260) 463-3775

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28234112A
IN
363L00000X
Nurse Practitioner
Primary
71012167A
IN

Other

Enumeration date
01/11/2022
Last updated
09/19/2025
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