Healthcare Provider Details

I. General information

NPI: 1407009798
Provider Name (Legal Business Name): KARISA DAWN JANSEN R.D., L.M.N.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARISA DAWN RANDALL R.D., L.M.N.T

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 CASS STREET
OMAHA NE
68114
US

IV. Provider business mailing address

7910 CASS STREET
OMAHA NE
68114
US

V. Phone/Fax

Practice location:
  • Phone: 402-384-8668
  • Fax: 402-384-9457
Mailing address:
  • Phone: 402-384-8668
  • Fax: 402-384-9457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00941448
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: