Provider Demographics
NPI:1740671213
Name:JENSEN, MARGAUX LYDIA
Entity type:Individual
Prefix:
First Name:MARGAUX
Middle Name:LYDIA
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 1:628 UNIVERSITY AVE SE
Mailing Address - Street 2:APT 205
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2123
Mailing Address - Country:US
Mailing Address - Phone:612-968-2561
Mailing Address - Fax:
Practice Address - Street 1:8225 FLYING CLOUD DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5315
Practice Address - Country:US
Practice Address - Phone:952-944-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN726474183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician