Provider Demographics
NPI:1497368039
Name:JENSEN, DONNA T
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:T
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:T
Other - Last Name:DENOBREGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 MARQUETTE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2022
Mailing Address - Country:US
Mailing Address - Phone:516-243-2677
Mailing Address - Fax:
Practice Address - Street 1:23 MARQUETTE DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2022
Practice Address - Country:US
Practice Address - Phone:516-243-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist