Provider Demographics
NPI:1023089851
Name:JENSEN, REGINA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARIE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4536 TECHNOLOGY DR STE 3
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2153
Mailing Address - Country:US
Mailing Address - Phone:910-343-8411
Mailing Address - Fax:910-343-8414
Practice Address - Street 1:4536 TECHNOLOGY DR
Practice Address - Street 2:STE 3
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2153
Practice Address - Country:US
Practice Address - Phone:910-343-8411
Practice Address - Fax:910-343-8414
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC36541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F54309Medicare UPIN
SC2184289BMedicare PIN