Healthcare Provider Details

I. General information

NPI: 1235210592
Provider Name (Legal Business Name): LAURA A JANSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 LEE ST
CHARLOTTESVILLE VA
22908-1002
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5129
  • Fax: 434-924-9068
Mailing address:
  • Phone:
  • Fax: 314-454-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101252279
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2018014102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: