Healthcare Provider Details

I. General information

NPI: 1720914849
Provider Name (Legal Business Name): DARLAEN KAY JANSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 10TH AVE
ANTIGO WI
54409-1015
US

IV. Provider business mailing address

1900 10TH AVE
ANTIGO WI
54409-1015
US

V. Phone/Fax

Practice location:
  • Phone: 715-623-7611
  • Fax: 715-623-7624
Mailing address:
  • Phone: 715-623-7611
  • Fax: 715-623-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number79732-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: