| NPI | 1982678264 | 
|---|---|
| Former Name | LISA JANSEN | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD CP000239) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SD 0239) | 
| Enumeration Date | 2006-02-14 | 
| Last Update Date | 2019-06-10 |