Provider Demographics
NPI:1609654748
Name:JANSEN, JULIA E (PMHNP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:E
Last Name:JANSEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20857 SE HUMBER LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3763
Mailing Address - Country:US
Mailing Address - Phone:360-529-1667
Mailing Address - Fax:
Practice Address - Street 1:1001 SW DISK DR STE 250
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3754
Practice Address - Country:US
Practice Address - Phone:541-293-1325
Practice Address - Fax:541-229-1314
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10021781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty