Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 1575 | NE |
NPI | 1003147091 |
---|---|
Provider Name | Ms. Kay A. Jantzen |
First Address | Lincoln, NE 68506-2845 |
Second Address | Lincoln, NE 68506-2845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 15/01/2010 |