Provider Demographics
NPI:1689676736
Name:JENSEN, DONNA (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 JOHNSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2356
Mailing Address - Country:US
Mailing Address - Phone:740-264-8600
Mailing Address - Fax:740-346-0298
Practice Address - Street 1:4100 JOHNSON RD STE 100
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2356
Practice Address - Country:US
Practice Address - Phone:740-264-8760
Practice Address - Fax:740-346-0298
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005154207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34005154OtherSTATE LICENSE NUMBER
OH207VX0000XOtherTAXONOMY NUMBER
OHJEO696773Medicare ID - Type Unspecified
OH207VX0000XOtherTAXONOMY NUMBER
OH0837287Medicaid