Provider Demographics
NPI:1124653514
Name:JANSAK, WILLIAM A (APRN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:JANSAK
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE RICHARD M. ROSS HEART HOSPITAL, 4TH FLOOR
Mailing Address - Street 2:452 WEST 10TH AVE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-293-9450
Mailing Address - Fax:614-293-9451
Practice Address - Street 1:THE RICHARD M. ROSS HEART HOSPITAL, 4TH FLOOR
Practice Address - Street 2:452 WEST 10TH AVE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-9450
Practice Address - Fax:614-293-9451
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.223658363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health