Healthcare Provider Details

I. General information

NPI: 1154132132
Provider Name (Legal Business Name): ANTOINETTE JANSON MSN, RN, SANE-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 BRIARCREST DR
BRYAN TX
77802-2763
US

IV. Provider business mailing address

1716 BRIARCREST DR
BRYAN TX
77802-2763
US

V. Phone/Fax

Practice location:
  • Phone: 979-217-1477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1056940
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: