Provider Demographics
NPI:1851287155
Name:JANZEN, SYMANTHA LYNN
Entity type:Individual
Prefix:
First Name:SYMANTHA
Middle Name:LYNN
Last Name:JANZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYMANTHA
Other - Middle Name:LYNN
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:908 SUNRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-4186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:72245 574TH AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68424-3908
Practice Address - Country:US
Practice Address - Phone:620-910-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE60296728Medicaid