Individual
NICK JANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
SONGSONG VILLAGE, ROTA, MP 96951-1249
(670) 532-9461
(670) 532-0698
Mailing address
PO BOX 1249, ROTA, MP 96951-1249
(670) 532-9461
(670) 532-0698
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2161
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2012
Last updated
10/23/2025
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