Most Relevant Information
Provider Data
| NPI Number: | 1003675109 |
| Provider Name: | NICHOLAS FANSELOW |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/19/2024 |
| Last Updated: | 06/05/2024 |
Provider Practice Location
620 JOHN PAUL JONES CIR
PORTSMOUTH
VA
237082111
Practice Location Phone/Fax
| Phone: | 7579530669 |
| Fax: |
Provider Mailing Location
620 JOHN PAUL JONES CIR
PORTSMOUTH
VA
237082111
Provider Mailing Phone/Fax
| Phone: | 7579530669 |
| Fax: |