Healthcare Provider Details

I. General information

NPI: 1932036662
Provider Name (Legal Business Name): JANINA KRYSTYNA THELEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 W. ST. JOE LANSING MICHIGAN 48917
LANSING MI
48917
US

IV. Provider business mailing address

4004 W. ST. JOE LANSING MICHIGAN 48917
LANSING MI
48917
US

V. Phone/Fax

Practice location:
  • Phone: 517-234-5434
  • Fax:
Mailing address:
  • Phone: 517-234-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501004534
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: