Healthcare Provider Details

I. General information

NPI: 1205764875
Provider Name (Legal Business Name): AMY D JENSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 2ND S
PRESTON ID
83263-1526
US

IV. Provider business mailing address

543 S 2600 E
PRESTON ID
83263-5427
US

V. Phone/Fax

Practice location:
  • Phone: 208-851-9953
  • Fax: 208-851-9953
Mailing address:
  • Phone: 208-852-2233
  • Fax: 208-852-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number48385
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: