Provider Demographics
NPI:1003578428
Name:JENSEN, MAUREEN MCDEVITT
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MCDEVITT
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 LAKEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9519
Mailing Address - Country:US
Mailing Address - Phone:906-250-4975
Mailing Address - Fax:906-273-1312
Practice Address - Street 1:769 LAKEWOOD LN
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9519
Practice Address - Country:US
Practice Address - Phone:906-250-4975
Practice Address - Fax:906-273-1312
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704156998163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management