Provider Demographics
NPI:1518474535
Name:JENSEN, JESSICA (DME PROVIDER)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DME PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 N TRIUMPH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4991
Mailing Address - Country:US
Mailing Address - Phone:888-550-8559
Mailing Address - Fax:
Practice Address - Street 1:3450 N TRIUMPH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4991
Practice Address - Country:US
Practice Address - Phone:888-550-8559
Practice Address - Fax:888-550-8559
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1992079263OtherNPI