NICHOLAS FANSELOW

PORTSMOUTH, VA
NPI1003675109
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy171000000X Military Health Care Provider
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2024-03-19
Last Update Date2024-06-05
Business Address
NICHOLAS FANSELOW
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708-2111
Phone number: 757-953-0669
Mailing Address
NICHOLAS FANSELOW
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708-2111
Phone number: 757-953-0669