Provider Demographics
NPI:1184068751
Name:JENSEN, THOMAS M (RD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:JENSEN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 MAIN ST
Mailing Address - Street 2:UNIT 8
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4709
Mailing Address - Country:US
Mailing Address - Phone:970-686-9117
Mailing Address - Fax:970-686-5441
Practice Address - Street 1:1180 MAIN ST
Practice Address - Street 2:UNIT 8
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4709
Practice Address - Country:US
Practice Address - Phone:970-686-9117
Practice Address - Fax:970-686-5441
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered