Provider Demographics
NPI:1073059853
Name:JENSEN, BRITTANY SCHAE
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:SCHAE
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 1:4049 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14418-9509
Mailing Address - Country:US
Mailing Address - Phone:315-719-7552
Mailing Address - Fax:
Practice Address - Street 1:4049 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:BRANCHPORT
Practice Address - State:NY
Practice Address - Zip Code:14418-9509
Practice Address - Country:US
Practice Address - Phone:315-719-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327173164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse