Healthcare Provider Details

I. General information

NPI: 1083216063
Provider Name (Legal Business Name): MICHAELA ANN JENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 UNIVERSITY AVE
DES MOINES IA
50311-3423
US

IV. Provider business mailing address

7051 BROOKVIEW DR
URBANDALE IA
50322-8006
US

V. Phone/Fax

Practice location:
  • Phone: 515-996-5935
  • Fax:
Mailing address:
  • Phone: 402-650-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099610
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: