MEDICARE: CHERYL M JENSEN A.P.R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	198809-4405	UT

General Provider Information

NPI Number	:	1285696187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL M JENSEN A.P.R.N.

Provider Business Mailing Address
First Line	:	11167 SANDY GULCH RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-5315
Country	:	US
Telephone Number	:	801-619-4802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 E. MURRAY HOLLADAY RD
Second Line	:	SUITE 222
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5185
Country	:	US
Telephone Number	:	801-278-0499
Fax Number	:	801-278-0489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/08/2007

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