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Individual

STACY L JANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
510 PARK ST, ANDERSON, MO 64831-9280
(417) 845-0545
(417) 845-0548
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 845-0545
(417) 845-0548

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2000156458
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
129295
ANTHEM
MO
01
P00279800
RR MEDICARE
Enumeration date
06/17/2005
Last updated
10/18/2007
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