Healthcare Provider Details

I. General information

NPI: 1881188621
Provider Name (Legal Business Name): SANDRA DARLENE JANSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 WALNUT PARK DR
SANTA BARBARA CA
93111-1738
US

IV. Provider business mailing address

5127 WALNUT PARK DR
SANTA BARBARA CA
93111-1738
US

V. Phone/Fax

Practice location:
  • Phone: 805-705-8199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number156301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: