Provider Demographics
NPI:1790902054
Name:JENSEN, ROBERT E (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-3122
Mailing Address - Country:US
Mailing Address - Phone:732-668-9498
Mailing Address - Fax:
Practice Address - Street 1:25 STATE ST
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-3122
Practice Address - Country:US
Practice Address - Phone:732-668-9498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse