Healthcare Provider Details

I. General information

NPI: 1003819509
Provider Name (Legal Business Name): JULIA MARIE JENSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MAIN ST STE 100
BOISE ID
83702-7261
US

IV. Provider business mailing address

111 W MAIN ST
BOISE ID
83702-7261
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-7400
  • Fax: 208-342-1979
Mailing address:
  • Phone: 208-342-7400
  • Fax: 208-342-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberO-0719
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: