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Individual
STACEY M JANTSCH
Active
Individual
STACEY M JANTSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704415079
MI
363LA2200X
Adult Health Nurse Practitioner
F310040-01
NY
363LF0000X
Family Nurse Practitioner
Primary
310040
NY
363LG0600X
Gerontology Nurse Practitioner
310040
NY
363LP2300X
Primary Care Nurse Practitioner
310040
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0055828
—
OH
05
—
06431149
—
NY
05
—
1861091324
—
MI
05
—
D401115801
—
CT
Enumeration date
10/25/2020
Last updated
08/20/2024
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