Provider Demographics
NPI:1790164770
Name:JENSEN, DANE BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:BRUCE
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6130
Mailing Address - Country:US
Mailing Address - Phone:715-717-5899
Mailing Address - Fax:
Practice Address - Street 1:535 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1449
Practice Address - Country:US
Practice Address - Phone:715-243-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-24
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN620492084P0800X
WI74409-202084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry