Provider Demographics
NPI:1972236867
Name:JENSEN, LISA
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:JENSEN
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 1:2304 GREENBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2367
Mailing Address - Country:US
Mailing Address - Phone:763-670-8804
Mailing Address - Fax:
Practice Address - Street 1:2304 GREENBRIAR LN
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2367
Practice Address - Country:US
Practice Address - Phone:763-670-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN97011171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN97011OtherMN DEPT. OF HEALTH INTERPRETER ROSTER NUMBER