Healthcare Provider Details

I. General information

NPI: 1770768095
Provider Name (Legal Business Name): COURTNEY ANN JENSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2008
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LEWISTON ME
04240-7027
US

IV. Provider business mailing address

300 MAIN ST
LEWISTON ME
04240-7027
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-2440
  • Fax: 207-795-2444
Mailing address:
  • Phone: 207-795-2440
  • Fax: 207-795-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number018386
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: