Provider Demographics
NPI:1528397569
Name:JENSEN, DEVIN SHAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:SHAWN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12707 120TH AVE NE
Mailing Address - Street 2:#203
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7500
Mailing Address - Country:US
Mailing Address - Phone:425-820-1221
Mailing Address - Fax:425-821-9362
Practice Address - Street 1:12707 120TH AVE NE
Practice Address - Street 2:#203
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7500
Practice Address - Country:US
Practice Address - Phone:425-820-1221
Practice Address - Fax:425-821-9362
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATA60113736363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7126667Medicaid
WA7126667Medicaid