Provider Demographics
NPI:1154634871
Name:JANZ, CHRISTINE K (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:K
Last Name:JANZ
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 1:1901 PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2004
Mailing Address - Country:US
Mailing Address - Phone:608-209-0761
Mailing Address - Fax:
Practice Address - Street 1:1901 PERIMETER ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1867
Practice Address - Country:US
Practice Address - Phone:608-209-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305985031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse