Provider Demographics
NPI:1679708457
Name:JANSEN, MARY ADELE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ADELE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EAST GATE BLVD.
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-741-8600
Mailing Address - Fax:516-408-3111
Practice Address - Street 1:825 EAST GATE BLVD.
Practice Address - Street 2:SUITE 101B
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-741-8600
Practice Address - Fax:516-408-3111
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY391259-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse