Healthcare Provider Details

I. General information

NPI: 1194904235
Provider Name (Legal Business Name): ROSE ANNE JANSSEN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 E MINNESOTA ST
SAINT JOSEPH MN
56374-8618
US

IV. Provider business mailing address

1511 E MINNESOTA ST PO BOX 188
SAINT JOSEPH MN
56374-8618
US

V. Phone/Fax

Practice location:
  • Phone: 320-363-7460
  • Fax:
Mailing address:
  • Phone: 320-363-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: