Provider Demographics
NPI:1396135190
Name:JANTZ, DEENA (RN, LMT, CHLC)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:JANTZ
Suffix:
Gender:F
Credentials:RN, LMT, CHLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2321
Mailing Address - Country:US
Mailing Address - Phone:563-321-9797
Mailing Address - Fax:
Practice Address - Street 1:75 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2321
Practice Address - Country:US
Practice Address - Phone:563-321-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA132817163W00000X
IA02610163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163W00000XNursing Service ProvidersRegistered Nurse