Provider Demographics
NPI:1073961520
Name:JENS, AMY (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:JENS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CARBON ST
Mailing Address - Street 2:#5
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6412
Mailing Address - Country:US
Mailing Address - Phone:406-698-3265
Mailing Address - Fax:406-969-4514
Practice Address - Street 1:712 CARBON ST
Practice Address - Street 2:#5
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6412
Practice Address - Country:US
Practice Address - Phone:406-698-3265
Practice Address - Fax:406-969-4514
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-5941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist