Provider Demographics
NPI:1740239904
Name:JENSON, BSHARON C (MD)
Entity Type:Individual
Prefix:DR
First Name:BSHARON
Middle Name:C
Last Name:JENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:B
Other - Middle Name:SHARON
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 84642
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5942
Mailing Address - Country:US
Mailing Address - Phone:425-297-5590
Mailing Address - Fax:425-297-5595
Practice Address - Street 1:1717 13TH ST STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1621
Practice Address - Country:US
Practice Address - Phone:425-297-5597
Practice Address - Fax:425-297-5598
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8121238Medicaid
WAE20079Medicare UPIN
WAGAB20554Medicare PIN