Provider Demographics
NPI:1518242908
Name:JENSEN, JULIE ANN (DIETICIAN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DIETICIAN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:ERTL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN MEDICAL STAFF SERVICES
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 FLORMANN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-718-3300
Practice Address - Fax:605-718-3426
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0380133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist