Provider Demographics
NPI:1528569571
Name:JANTZEN, DAWN CHERIE
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:CHERIE
Last Name:JANTZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24945 AUBERRY RD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9612
Mailing Address - Country:US
Mailing Address - Phone:559-825-2977
Mailing Address - Fax:
Practice Address - Street 1:7339 NORTH FIRST STREET
Practice Address - Street 2:#110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:916-729-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist