Provider Demographics
NPI:1740241942
Name:JENSEN, MALEA ANN (DO)
Entity Type:Individual
Prefix:
First Name:MALEA
Middle Name:ANN
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 1:1000 73RD ST STE 23
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1321
Mailing Address - Country:US
Mailing Address - Phone:515-267-1961
Mailing Address - Fax:515-225-4427
Practice Address - Street 1:1000 73RD ST STE 23
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1321
Practice Address - Country:US
Practice Address - Phone:515-267-1961
Practice Address - Fax:515-225-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG18716Medicare UPIN