Provider Demographics
NPI:1356712293
Name:JANSSEN, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 AMERICAN WAY B
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604
Mailing Address - Country:US
Mailing Address - Phone:307-233-0246
Mailing Address - Fax:
Practice Address - Street 1:167 S CONWELL ST
Practice Address - Street 2:STE #3
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2749
Practice Address - Country:US
Practice Address - Phone:307-233-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY23702.1441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY23702.1441OtherNP