Provider Demographics
NPI:1669737300
Name:JENSON, JODY LYNN (MSN,APRN,PMHNP)
Entity type:Individual
Prefix:MR
First Name:JODY
Middle Name:LYNN
Last Name:JENSON
Suffix:
Gender:M
Credentials:MSN,APRN,PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49725 COUNTY 83
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-5280
Mailing Address - Country:US
Mailing Address - Phone:218-894-8854
Mailing Address - Fax:218-894-8867
Practice Address - Street 1:49725 COUNTY 83
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-5280
Practice Address - Country:US
Practice Address - Phone:218-894-8854
Practice Address - Fax:218-894-8867
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1189A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health