Provider Demographics
NPI:1255030045
Name:JENSEN, JANAE MICHELLE
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:MICHELLE
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 1:11375 W BRIDGETOWER DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-7716
Mailing Address - Country:US
Mailing Address - Phone:208-816-0827
Mailing Address - Fax:
Practice Address - Street 1:11375 W BRIDGETOWER DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-7716
Practice Address - Country:US
Practice Address - Phone:208-816-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID75621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily