Provider Demographics
NPI:1679913255
Name:JENSEN, ERICA M (ARNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:M
Last Name:JENSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 KIMBALL AVE
Mailing Address - Street 2:PO BOX 2758
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9086
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-235-5607
Practice Address - Street 1:419 E DONALD ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1500
Practice Address - Country:US
Practice Address - Phone:319-236-1911
Practice Address - Fax:319-287-5832
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA120864363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA719270059Medicare PIN