Provider Demographics
NPI:1962643858
Name:JENSEN, JENNIFER J (CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-501-3300
Mailing Address - Fax:
Practice Address - Street 1:9600 S 1300 E STE 310
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3772
Practice Address - Country:US
Practice Address - Phone:801-501-3300
Practice Address - Fax:801-501-3310
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5453251-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife