Provider Demographics
NPI:1912019100
Name:JANSSEN, LAURA ANN (NP RN CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:NP RN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 KERNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4861
Mailing Address - Country:US
Mailing Address - Phone:415-499-4030
Mailing Address - Fax:415-499-5005
Practice Address - Street 1:3260 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4861
Practice Address - Country:US
Practice Address - Phone:415-499-4030
Practice Address - Fax:415-499-5005
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433036163WW0101X
CA12926363LW0102X
CA758367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health