Provider Demographics
NPI:1083487920
Name:JENSEN, SAMANTHA DEE (ARNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DEE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DEE
Other - Last Name:KUCHARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1131 CORNERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-8916
Mailing Address - Country:US
Mailing Address - Phone:515-344-1762
Mailing Address - Fax:
Practice Address - Street 1:1378 NW 124TH ST # 200
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8151
Practice Address - Country:US
Practice Address - Phone:515-288-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA176763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner