Provider Demographics
NPI:1073120606
Name:EYRE, JENSEN (CHES)
Entity Type:Individual
Prefix:
First Name:JENSEN
Middle Name:
Last Name:EYRE
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S 500 E STE 202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1094
Mailing Address - Country:US
Mailing Address - Phone:801-582-2011
Mailing Address - Fax:801-582-2011
Practice Address - Street 1:34 S 500 E STE 202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1094
Practice Address - Country:US
Practice Address - Phone:801-582-2011
Practice Address - Fax:801-582-2011
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1101X, 390200000X
UT33951133NN1002X, 171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program