Individual
JANTZEN MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
4039 HIGHLAND ST, SUITE 2, MILAN, TN 38358-3483
(731) 723-1327
(731) 660-8739
Mailing address
1804 HIGHWAY 45 BYP, SUITE 604, JACKSON, TN 38305-4436
(731) 660-7971
(731) 660-8739
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
65174
TN
Other
Enumeration date
09/13/2013
Last updated
09/13/2013
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