Healthcare Provider Details

I. General information

NPI: 1841541463
Provider Name (Legal Business Name): SUSAN E JENSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13090 N. 94TH DR SUITE 101
PEORIA AZ
85381-4257
US

IV. Provider business mailing address

7558 W THUNDERBIRD RD SUITE 1-496
PEORIA AZ
85381-6080
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-2707
  • Fax: 623-977-2331
Mailing address:
  • Phone: 480-985-1093
  • Fax: 480-296-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN092913
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: