MEDICARE: GP JENSEN LP

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	103T00000X	Psychologist	0810000963	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1093725160	OTHER	VA	INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1316381916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GP JENSEN LP

Provider Business Mailing Address
First Line	:	6353 CENTER DR
Second Line	:	STE 204
City	:	NORFOLK
State	:	VA
Zip	:	23502-4112
Country	:	US
Telephone Number	:	757-461-3313
Fax Number	:	757-461-8363

Provider Business Practice Location Address
First Line	:	6353 CENTER DR
Second Line	:	STE 204
City	:	NORFOLK
State	:	VA
Zip	:	23502-4112
Country	:	US
Telephone Number	:	757-461-3313
Fax Number	:	757-461-8363

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHERYL H TANT
Credential	:
Telephone Number	:	757-461-3313

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/24/2017

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Directions to “GP JENSEN LP ” Practice Location

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