Healthcare Provider Details

I. General information

NPI: 1356920318
Provider Name (Legal Business Name): NATALIE ANNE JANSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4100
  • Fax:
Mailing address:
  • Phone: 617-667-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1018365
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: