Provider Demographics
NPI:1003673104
Name:JENSEN, GABRIELLE MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARIE
Last Name:JENSEN
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:MARIE
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:34700 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4500
Mailing Address - Country:US
Mailing Address - Phone:262-646-4411
Mailing Address - Fax:262-646-1049
Practice Address - Street 1:500 N 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4873
Practice Address - Country:US
Practice Address - Phone:800-767-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14888-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health