Healthcare Provider Details

I. General information

NPI: 1477557908
Provider Name (Legal Business Name): LOIS A JENSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 RIO LINDO AVE
CHICO CA
95926-1817
US

IV. Provider business mailing address

337 W CLARK ST., P.O.BOX 4887
EUREKA CA
95501
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-3491
  • Fax:
Mailing address:
  • Phone: 530-345-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number46948
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC50040
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberC50040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: