Provider Demographics
NPI:1619208444
Name:JENSEN, SHAWN (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:WENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2383
Mailing Address - Country:US
Mailing Address - Phone:262-893-7641
Mailing Address - Fax:
Practice Address - Street 1:4855 S MOORLAND RD STE 250
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7494
Practice Address - Country:US
Practice Address - Phone:262-789-6020
Practice Address - Fax:262-789-6025
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI161673-30163WP0200X
WI13131-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics