Provider Demographics
NPI:1619067964
Name:JENSEN, LANI L (RN)
Entity Type:Individual
Prefix:MRS
First Name:LANI
Middle Name:L
Last Name:JENSEN
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 1:1995 E COALTON RD APT 78-101
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4517
Mailing Address - Country:US
Mailing Address - Phone:303-521-3160
Mailing Address - Fax:
Practice Address - Street 1:6303 WADSWORTH BYPASS
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003
Practice Address - Country:US
Practice Address - Phone:303-275-7543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO170512163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00954331Medicaid