Provider Demographics
NPI:1790754885
Name:JENSEN, ELSE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSE
Middle Name:MARIE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 APPLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4302
Mailing Address - Country:US
Mailing Address - Phone:707-258-1774
Mailing Address - Fax:
Practice Address - Street 1:1510 4TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1717
Practice Address - Country:US
Practice Address - Phone:510-525-8980
Practice Address - Fax:510-525-8982
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G685330Medicaid
CA00G685330Medicaid
F16269Medicare UPIN
CA00AG685332Medicare PIN
CAP00022828Medicare PIN