Healthcare Provider Details

I. General information

NPI: 1437169166
Provider Name (Legal Business Name): MARILYN HEPPNER JANZEN PH.D.,A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 34TH ST
JOPLIN MO
64804-3933
US

IV. Provider business mailing address

2448 S MINNESOTA AVE
JOPLIN MO
64804-2240
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7065
  • Fax:
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR686398
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number056840
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: