Provider Demographics
NPI:1568058733
Name:JENSEN, MELANIE MARIE (ARNP, CNM)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MARIE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:MARIE
Other - Last Name:SMOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9750 LEVIN RD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8399
Mailing Address - Country:US
Mailing Address - Phone:360-649-6275
Mailing Address - Fax:
Practice Address - Street 1:1800 NW MYHRE RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7663
Practice Address - Country:US
Practice Address - Phone:360-649-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60286253390200000X
WAAP61188070363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program