Provider Demographics
NPI:1720050297
Name:JENSEN, CHRISTINE T (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:T
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 1:101 IOWA AVE W
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4768
Mailing Address - Country:US
Mailing Address - Phone:641-754-6700
Mailing Address - Fax:647-753-1375
Practice Address - Street 1:101 IOWA AVE W
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158
Practice Address - Country:US
Practice Address - Phone:641-754-6700
Practice Address - Fax:641-753-1375
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41013OtherWELLMARK BCBS
IA0634600Medicaid
IA3177113Medicaid
IA41001OtherWELLMARK BCBS
IA4177113Medicaid
IA41014OtherWELLMARK BCBS
IA15307Medicare ID - Type Unspecified
IA3177113Medicaid
IA41014OtherWELLMARK BCBS
IA41001OtherWELLMARK BCBS