Provider Demographics
NPI:1851604904
Name:JENSEN, LEONARD (FNP)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 E IRON EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6871
Mailing Address - Country:US
Mailing Address - Phone:208-209-3242
Mailing Address - Fax:208-549-7880
Practice Address - Street 1:1159 E IRON EAGLE DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6871
Practice Address - Country:US
Practice Address - Phone:208-209-3242
Practice Address - Fax:208-549-7880
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050116NP363LF0000X
IDNP1166A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily