Provider Demographics
NPI:1013509306
Name:JENSEN, SHANNA KAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:KAY
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:KAY
Other - Last Name:LEISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:803 PROVIDENCE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1590
Mailing Address - Country:US
Mailing Address - Phone:402-375-8862
Mailing Address - Fax:402-375-8863
Practice Address - Street 1:803 PROVIDENCE RD STE 101
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1590
Practice Address - Country:US
Practice Address - Phone:402-375-8862
Practice Address - Fax:402-375-8863
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist