Provider Demographics
NPI:1710749874
Name:JENSEN, SHARINA E (CD(DONA), CLC)
Entity Type:Individual
Prefix:
First Name:SHARINA
Middle Name:E
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CD(DONA), CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 W BURY ST
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-2374
Mailing Address - Country:US
Mailing Address - Phone:208-340-5131
Mailing Address - Fax:
Practice Address - Street 1:726 W BURY ST
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-2374
Practice Address - Country:US
Practice Address - Phone:208-340-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2522210174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN