Individual
JASON MATTHEW FANSLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11108 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1730
(260) 266-5700
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71011989A
IN
363LF0000X
Family Nurse Practitioner
F10210869
IN
Other
Enumeration date
11/12/2021
Last updated
10/17/2022
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