Healthcare Provider Details

I. General information

NPI: 1639492929
Provider Name (Legal Business Name): DEBORAH TERESA JANSEN R.N,,M.S.N,P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 OFARRELL ST
SAN FRANCISCO CA
94115-3357
US

IV. Provider business mailing address

2200 OFARRELL ST
SAN FRANCISCO CA
94115-3357
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-9198
  • Fax: 415-833-4177
Mailing address:
  • Phone: 415-833-9198
  • Fax: 415-833-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: