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General NPI Number Information
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NPI Number | 1992058945
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Entity Type | Individual
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Provider Name | STACEY MARIE JANSEN CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 40 W ERIE ST SUITE 203
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City | PAINESVILLE
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State | OH
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Zip | 44077-3274
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Country | US
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Telephone | 440-350-0832
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Fax | 440-354-7420
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Provider Business Mailing Address
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Address Line | 700 N COLUMBUS ST
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City | CRESTLINE
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State | OH
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Zip | 44827-1455
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Country | US
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Telephone |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | COA.14005-NA
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License Number State | OH
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