Provider Demographics
NPI:1326148479
Name:JAKSTAS, HELEN (RN,MHP,MS)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:JAKSTAS
Suffix:
Gender:F
Credentials:RN,MHP,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1476
Mailing Address - Country:US
Mailing Address - Phone:517-265-8134
Mailing Address - Fax:517-265-2249
Practice Address - Street 1:770 RIVERSIDE AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1476
Practice Address - Country:US
Practice Address - Phone:517-265-8134
Practice Address - Fax:517-265-2249
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704146563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily