Healthcare Provider Details

I. General information

NPI: 1033551429
Provider Name (Legal Business Name): DANIELLE E JANSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE E LEE FNP

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTHLAND DR
SIKESTON MO
63801-4403
US

IV. Provider business mailing address

420 SEMO DR
NEW MADRID MO
63869-1734
US

V. Phone/Fax

Practice location:
  • Phone: 573-472-1770
  • Fax: 573-472-1560
Mailing address:
  • Phone: 573-748-2404
  • Fax: 573-748-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2009034225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: