Provider Demographics
NPI:1003310111
Name:JENSEN, COLLEEN O'CONNOR (RN, PHN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:O'CONNOR
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N R ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-5226
Mailing Address - Country:US
Mailing Address - Phone:805-350-0130
Mailing Address - Fax:805-737-6412
Practice Address - Street 1:301 N R ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5226
Practice Address - Country:US
Practice Address - Phone:805-350-0130
Practice Address - Fax:805-737-6412
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566236163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health