Provider Demographics
NPI:1578957783
Name:JANSEN, PATRICIA ELLEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:JANSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1916
Mailing Address - Country:US
Mailing Address - Phone:517-540-6845
Mailing Address - Fax:517-548-6766
Practice Address - Street 1:1425 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1916
Practice Address - Country:US
Practice Address - Phone:517-540-6845
Practice Address - Fax:517-548-6766
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206491163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool