Provider Demographics
NPI:1508963729
Name:JENSON, JENNIFER SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUE
Last Name:JENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:KIESEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:804 KENYON RD STE D
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5744
Mailing Address - Country:US
Mailing Address - Phone:515-574-6855
Mailing Address - Fax:515-573-7274
Practice Address - Street 1:804 KENYON RD STE D
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5744
Practice Address - Country:US
Practice Address - Phone:515-574-6855
Practice Address - Fax:515-573-7274
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22826208000000X
IA40574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4707711013Medicaid
I47589Medicare UPIN
NE4707711013Medicaid