Provider Demographics
NPI:1831442235
Name:JENSEN, ANDREW (CRNA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1526 LEGEND TRAIL DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2555
Mailing Address - Country:US
Mailing Address - Phone:503-804-9498
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-414-2000
Practice Address - Fax:360-414-7638
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS43-557134-111367500000X
WAAP60633494367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered