Provider Demographics
NPI:1750846259
Name:JENSEN, JENNIFER DALE
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DALE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5346
Mailing Address - Country:US
Mailing Address - Phone:208-344-5502
Mailing Address - Fax:
Practice Address - Street 1:419 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5332
Practice Address - Country:US
Practice Address - Phone:208-344-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator