Provider Demographics
NPI:1548419708
Name:JENSON, MELISSA NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:NICOLE
Last Name:JENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:14 SOUTH MAIN STREET
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621
Mailing Address - Country:US
Mailing Address - Phone:218-694-3444
Mailing Address - Fax:218-694-3443
Practice Address - Street 1:14 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621
Practice Address - Country:US
Practice Address - Phone:218-694-3444
Practice Address - Fax:218-694-3443
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR175807-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse