Healthcare Provider Details

I. General information

NPI: 1932402690
Provider Name (Legal Business Name): CHRISTINE ANN JENSEN R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E 90TH DR STE B
MERRILLVILLE IN
46410-8102
US

IV. Provider business mailing address

270 E 90TH DR STE B
MERRILLVILLE IN
46410-8102
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-1758
  • Fax: 219-736-1717
Mailing address:
  • Phone: 219-736-1758
  • Fax: 219-736-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number716125
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: