Healthcare Provider Details

I. General information

NPI: 1073505251
Provider Name (Legal Business Name): CHAD M JANZEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COMMODORE ST
PRATT KS
67124-2903
US

IV. Provider business mailing address

PO BOX 388
NEWTON KS
67114-0388
US

V. Phone/Fax

Practice location:
  • Phone: 620-672-7451
  • Fax:
Mailing address:
  • Phone: 316-281-3700
  • Fax: 316-686-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55411
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: