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General NPI Number Information
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NPI Number | 1144762436
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Entity Type | Organization
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Legal Business Name | ELIZABETH ANNE JANSEN
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 20 SALISBURY AVE
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City | STEWART MANOR
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State | NY
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Zip | 11530-3838
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Country | US
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Telephone | 516-652-7432
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Fax |
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Provider Business Mailing Address
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Address Line | 20 SALISBURY AVE
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City | STEWART MANOR
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State | NY
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Zip | 11530-3838
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Country | US
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Telephone | 516-652-7432
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MRS. ELIZABETH ANNE JANSEN
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Credential | NP
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Telephone | 516-652-7432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 307681
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License Number State | NY
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