Healthcare Provider Details

I. General information

NPI: 1639574213
Provider Name (Legal Business Name): GUZEL AIKOVNA JANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 S 16TH ST STE A
WILMINGTON NC
28401-6491
US

IV. Provider business mailing address

PO BOX 15109
WILMINGTON NC
28408-5109
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-8633
  • Fax: 910-452-8569
Mailing address:
  • Phone: 910-392-2525
  • Fax: 910-392-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5016351
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024172004
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: