Provider Demographics
NPI:1265677280
Name:JENSEN, CHRISTINA SUE (ANP-BC, APNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SUE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:ANP-BC, APNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:KEEDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC, APNP
Mailing Address - Street 1:9200 W WISCONSIN AVENUE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6850
Mailing Address - Fax:414-805-6851
Practice Address - Street 1:9200 W WISCONSIN AVE FL 4
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6850
Practice Address - Fax:414-805-6851
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3607-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1265677280Medicaid