Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP128910 | TX |
NPI | 1073985024 |
---|---|
Provider Name | Melissa Jansen |
First Address | Dallas, TX 75235-7709 |
Second Address | Dallas, TX 75235-7709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 28/10/2015 |