Provider Demographics
NPI:1033364203
Name:JANSEN, MARILYN ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:ANN
Last Name:JANSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 E ACADEMY BLVD UNIT 704
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7166
Mailing Address - Country:US
Mailing Address - Phone:303-341-1192
Mailing Address - Fax:
Practice Address - Street 1:6360 W CENTER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3401
Practice Address - Country:US
Practice Address - Phone:303-347-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41656164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse