Individual
JENNIFER MARY FASULO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3734 SE 15TH AVE, APT 1, PORTLAND, OR 97202-3857
(203) 228-0805
Mailing address
510 E 15TH ALY, APT 3, EUGENE, OR 97401-4580
(203) 228-0805
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201243142RN
OR
Other
Enumeration date
11/05/2010
Last updated
11/02/2012
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