Provider Demographics
NPI:1992480214
Name:JANSEN, ALLYSON
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:JANSEN
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 1:260 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:WI
Mailing Address - Zip Code:53803-8008
Mailing Address - Country:US
Mailing Address - Phone:608-732-9950
Mailing Address - Fax:
Practice Address - Street 1:260 CREEK DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:WI
Practice Address - Zip Code:53803-8008
Practice Address - Country:US
Practice Address - Phone:608-732-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program