Provider Demographics
NPI:1912192790
Name:JENSEN, ALLISUN GARLAND (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISUN
Middle Name:GARLAND
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2470
Mailing Address - Country:US
Mailing Address - Phone:406-363-5104
Mailing Address - Fax:406-363-2894
Practice Address - Street 1:411 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2470
Practice Address - Country:US
Practice Address - Phone:406-363-5104
Practice Address - Fax:406-363-2894
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT510363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical