Provider Demographics
NPI:1972138303
Name:JENSEN, MORGAN PATRICE (RN)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:PATRICE
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 1:12247 S BEACON LIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-8000
Mailing Address - Country:US
Mailing Address - Phone:608-931-7645
Mailing Address - Fax:
Practice Address - Street 1:12247 S BEACON LIGHT RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-8000
Practice Address - Country:US
Practice Address - Phone:608-931-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI195682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse