Provider Information for 1902493554
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VELERY NICOLE FASANO-GILMAN MS
Sex: Female
NPI: 1902493554
Last Updated: 2020-12-30
Certification Date: 2020-12-06
Certification Date: 2020-12-06
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1902493554 | ||||||||||||||
| Enumeration Date | 2020-12-30 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1100 S KENNEY FORT BLVD ROUND ROCK, TX 78665-2024 United States Phone: 254-383-0053 | Fax: | ||||||||||||||
| Primary Practice Address | 123 YATES RD KILLEEN, TX 76549-6757 United States Phone: 254-432-4290 | Fax: | ||||||||||||||
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