Provider Demographics
NPI:1144762436
Name:ELIZABETH ANNE JANSEN
Entity Type:Organization
Organization Name:ELIZABETH ANNE JANSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-652-7432
Mailing Address - Street 1:20 SALISBURY AVE
Mailing Address - Street 2:
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3838
Mailing Address - Country:US
Mailing Address - Phone:516-652-7432
Mailing Address - Fax:
Practice Address - Street 1:20 SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530-3838
Practice Address - Country:US
Practice Address - Phone:516-652-7432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307681363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty