Provider Demographics
NPI:1952053738
Name:JENSON, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:JENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 BRYCE CANYON LN NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7843
Mailing Address - Country:US
Mailing Address - Phone:805-402-6214
Mailing Address - Fax:
Practice Address - Street 1:333 RIO RANCHO DR NE STE 200
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1458
Practice Address - Country:US
Practice Address - Phone:505-814-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist