Provider Demographics
NPI:1396061941
Name:FRANTZ, JAN KAREN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:KAREN
Last Name:FRANTZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SOUTHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1134
Mailing Address - Country:US
Mailing Address - Phone:937-698-6637
Mailing Address - Fax:
Practice Address - Street 1:213 SOUTHVIEW LN
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1134
Practice Address - Country:US
Practice Address - Phone:937-698-6637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167513163WA2000X, 163WM0705X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQUEENIE2Medicaid
OHQUEENIE2Medicare Oscar/Certification
OHQUEENIE2Medicare PIN
OHQUEENIE2Medicare UPIN