Provider Demographics
NPI:1952840043
Name:JENSEN, KRISTI LORRAINE (RN)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:LORRAINE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FLICKER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1345
Mailing Address - Country:US
Mailing Address - Phone:631-761-2636
Mailing Address - Fax:
Practice Address - Street 1:11 FLICKER DR
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1345
Practice Address - Country:US
Practice Address - Phone:631-761-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY724397163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse