Healthcare Provider Details

I. General information

NPI: 1629015722
Provider Name (Legal Business Name): SHEILA JENSEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/14/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 A ST STE 200
ANCHORAGE AK
99501-5147
US

IV. Provider business mailing address

4424 E BIRCH DR
WASILLA AK
99654-4510
US

V. Phone/Fax

Practice location:
  • Phone: 907-272-2423
  • Fax: 907-272-2428
Mailing address:
  • Phone: 907-357-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number195
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: