Provider Demographics
NPI:1093602385
Name:JENSEN, NEVIN
Entity type:Individual
Prefix:
First Name:NEVIN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:UT
Mailing Address - Zip Code:84518-0295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 295
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:UT
Practice Address - Zip Code:84518-0295
Practice Address - Country:US
Practice Address - Phone:435-749-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9336175-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist