Individual
JASON FANSELAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNIM
Contact information
Practice address
128 W 13TH ST, APT 1011, KANSAS CITY, MO 64105-1726
(972) 489-6170
Mailing address
128 W 13TH ST, APT 1011, KANSAS CITY, MO 64105-1726
(972) 489-6170
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
04/22/2016
Last updated
04/22/2016
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