Provider Demographics
NPI:1083848907
Name:JENSEN, JACQULINE MAE (RN)
Entity Type:Individual
Prefix:
First Name:JACQULINE
Middle Name:MAE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17230 NOOPIMING DR
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-4522
Mailing Address - Country:US
Mailing Address - Phone:320-532-7776
Mailing Address - Fax:320-532-7524
Practice Address - Street 1:17230 NOOPIMING DR
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-4522
Practice Address - Country:US
Practice Address - Phone:320-532-7776
Practice Address - Fax:320-532-7524
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 185380-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse