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General NPI Number Information
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NPI Number | 1356837710
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Entity Type | Individual
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Provider Name | BRIGITTA JANSEN MS, CNS, CDN
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Gender | Female
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 363 MAIN ST STE 513
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3359
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Country | US
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Telephone | 917-975-1784
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Fax |
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Provider Business Mailing Address
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Address Line | 29 ELM ST
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City | DEEP RIVER
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State | CT
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Zip | 06417-1740
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Country | US
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Telephone | 917-975-1784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 001594
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License Number State | CT
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