Provider Demographics
NPI:1114977212
Name:JANSEN, CHRISTINE D (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:JANSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 TELESTAR CT STE 300
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1263
Mailing Address - Country:US
Mailing Address - Phone:703-591-1688
Mailing Address - Fax:703-591-1445
Practice Address - Street 1:1005 N GLEBE RD
Practice Address - Street 2:#750
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5718
Practice Address - Country:US
Practice Address - Phone:703-524-7202
Practice Address - Fax:703-516-4501
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024097798363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1114977212Medicaid
VAVVH301AMedicare PIN
VAS84889Medicare UPIN
DC405905ZC3UMedicare PIN