Provider Demographics
NPI:1972026938
Name:JENSEN, DEBORAH ALICE (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ALICE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 HACKETT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8993
Mailing Address - Country:US
Mailing Address - Phone:603-668-8161
Mailing Address - Fax:
Practice Address - Street 1:633 MAPLE ST STE 5
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:NH
Practice Address - Zip Code:03229-3377
Practice Address - Country:US
Practice Address - Phone:603-746-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH075281-23363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care