Provider Demographics
NPI:1285388504
Name:JANSEN, HEATHER NICOLE (MS, APRN, FPMHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:MS, APRN, FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROLLING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3619
Mailing Address - Country:US
Mailing Address - Phone:518-368-4875
Mailing Address - Fax:
Practice Address - Street 1:2141 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-6343
Practice Address - Country:US
Practice Address - Phone:518-982-1274
Practice Address - Fax:518-982-1277
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403976363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty