Provider Demographics
NPI:1497717912
Name:JENSEN, FAYE WHITING (MD)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:WHITING
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:JOANNE
Other - Last Name:WHITING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:105 MARGARET LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5289
Mailing Address - Country:US
Mailing Address - Phone:530-272-9615
Mailing Address - Fax:
Practice Address - Street 1:105 MARGARET LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5289
Practice Address - Country:US
Practice Address - Phone:530-272-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36652174400000X
OK26002207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64036932Medicaid
KY0672904Medicare ID - Type Unspecified
KY64036932Medicaid