Provider Demographics
NPI:1497174445
Name:JENSEN, ANNETTE
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 RINALDI ST STE 320
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1255
Mailing Address - Country:US
Mailing Address - Phone:818-365-1616
Mailing Address - Fax:818-365-1811
Practice Address - Street 1:14901 RINALDI ST STE 320
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1255
Practice Address - Country:US
Practice Address - Phone:818-365-1616
Practice Address - Fax:818-365-1811
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95000559163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, AmbulatoryGroup - Multi-Specialty