Provider Demographics
NPI:1851087373
Name:JENSEN, GRACE KATHRYN (APRN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:KATHRYN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W ERIE ST APT 2003
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6990
Mailing Address - Country:US
Mailing Address - Phone:636-484-0127
Mailing Address - Fax:
Practice Address - Street 1:1053 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4432
Practice Address - Country:US
Practice Address - Phone:708-300-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily