MEDICARE: MISTY A JANSSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	22113	NE

General Provider Information

NPI Number	:	1154379014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY A JANSSEN M.D.

Provider Business Mailing Address
First Line	:	7261 MERCY RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10109 MAPLE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-5554
Country	:	US
Telephone Number	:	402-572-3500
Fax Number	:	402-572-3505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/30/2016

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