Provider Demographics
NPI:1770686628
Name:JENSEN, WARREN C (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:C
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MCCANNEL HALL, ROOM 100
Mailing Address - Street 2:2891 2ND AVENUE N., STOP 9038
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9038
Mailing Address - Country:US
Mailing Address - Phone:701-777-4500
Mailing Address - Fax:701-777-4835
Practice Address - Street 1:MCCANNEL HALL, ROOM 100
Practice Address - Street 2:2891 2ND AVENUE N., STOP 9038
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9038
Practice Address - Country:US
Practice Address - Phone:701-777-4500
Practice Address - Fax:701-777-4835
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ND48782083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14292Medicaid
ND14292Medicaid
NDE23830Medicare UPIN