Provider Demographics
NPI:1407009798
Name:JANSEN, KARISA DAWN (RD, LMNT)
Entity Type:Individual
Prefix:MRS
First Name:KARISA
Middle Name:DAWN
Last Name:JANSEN
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:MS
Other - First Name:KARISA
Other - Middle Name:DAWN
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LMNT
Mailing Address - Street 1:7910 CASS STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-384-8668
Mailing Address - Fax:402-384-9457
Practice Address - Street 1:7910 CASS STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-384-8668
Practice Address - Fax:402-384-9457
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE00941448133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered