Healthcare Provider Details

I. General information

NPI: 1801769468
Provider Name (Legal Business Name): MACKENZIE GRACE JENSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S GREENLEAF ST STE J
GURNEE IL
60031-3377
US

IV. Provider business mailing address

3 S GREENLEAF ST STE J
GURNEE IL
60031-3377
US

V. Phone/Fax

Practice location:
  • Phone: 847-599-1111
  • Fax:
Mailing address:
  • Phone: 847-599-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: