Provider Demographics
NPI:1407024037
Name:JENSEN, RACHAE A (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHAE
Middle Name:A
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 MOUNT VERNON RD SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-3864
Mailing Address - Country:US
Mailing Address - Phone:319-363-0474
Mailing Address - Fax:319-363-2170
Practice Address - Street 1:3500 MOUNT VERNON RD SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-3864
Practice Address - Country:US
Practice Address - Phone:319-363-0474
Practice Address - Fax:319-363-2170
Is Sole Proprietor?:No
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001853363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical