Provider Demographics
NPI:1356837710
Name:JANSEN, BRIGITTA (MS, CNS, CDN)
Entity type:Individual
Prefix:
First Name:BRIGITTA
Middle Name:
Last Name:JANSEN
Suffix:
Gender:F
Credentials:MS, CNS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-1740
Mailing Address - Country:US
Mailing Address - Phone:917-975-1784
Mailing Address - Fax:
Practice Address - Street 1:363 MAIN ST STE 513
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3359
Practice Address - Country:US
Practice Address - Phone:917-975-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001594133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist