Provider Demographics
NPI:1477750727
Name:JENSEN, VERONICA REYES (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:REYES
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:812-496-8772
Mailing Address - Fax:812-656-8084
Practice Address - Street 1:2018 JAMISON DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-8436
Practice Address - Country:US
Practice Address - Phone:812-496-8772
Practice Address - Fax:812-656-8084
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01063391A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200862780Medicaid
INM400066010Medicare PIN