Provider Demographics
NPI:1871250506
Name:JANTZ, NADENE
Entity type:Individual
Prefix:
First Name:NADENE
Middle Name:
Last Name:JANTZ
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 1:2209 JOHN TEE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1753
Mailing Address - Country:US
Mailing Address - Phone:405-669-1254
Mailing Address - Fax:
Practice Address - Street 1:2209 JOHN TEE DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1753
Practice Address - Country:US
Practice Address - Phone:405-669-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker