Provider Demographics
NPI:1932641594
Name:JENSON, EMILY (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:PONDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3935 E ROUGH RIDER RD.
Mailing Address - Street 2:#1352
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050
Mailing Address - Country:US
Mailing Address - Phone:602-432-2280
Mailing Address - Fax:
Practice Address - Street 1:14010 N NORTHSIGHT BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3601
Practice Address - Country:US
Practice Address - Phone:480-443-0384
Practice Address - Fax:480-443-0389
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6565363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical