MEDICARE: DR. LOIS A JENSEN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	46948	AZ
2	207V00000X	Obstetrics & Gynecology Physician	C50040	CA
3	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	C50040	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00169351	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1477557908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOIS A JENSEN M.D.

Provider Business Mailing Address
First Line	:	337 W CLARK ST., P.O.BOX 4887
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501
Country	:	US
Telephone Number	:	530-345-3491
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 RIO LINDO AVE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-1817
Country	:	US
Telephone Number	:	530-345-3491
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/15/2019

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