Healthcare Provider Details

I. General information

NPI: 1932028156
Provider Name (Legal Business Name): DONNA JANTZEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 N HARRISON AVE
SHAWNEE OK
74801-5206
US

IV. Provider business mailing address

508 CHERRY PL
OKLAHOMA CITY OK
73127-6216
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-7711
  • Fax:
Mailing address:
  • Phone: 405-204-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0059882
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: