Healthcare Provider Details

I. General information

NPI: 1447240890
Provider Name (Legal Business Name): KATHERINE A JANTZEN APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUNDEE PARK DR SUITE #303
ANDOVER MA
01810-3735
US

IV. Provider business mailing address

10 CITY VIEW RD
BROOKLINE MA
02446-2239
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-6950
  • Fax:
Mailing address:
  • Phone: 617-277-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number141135
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: