Healthcare Provider Details

I. General information

NPI: 1215010889
Provider Name (Legal Business Name): CHARMAINE B JENSEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 ATLANTIC HWY
LINCOLNVILLE ME
04849-5310
US

IV. Provider business mailing address

2239 ATLANTIC HWY
LINCOLNVILLE ME
04849-5310
US

V. Phone/Fax

Practice location:
  • Phone: 207-230-1007
  • Fax: 207-230-1008
Mailing address:
  • Phone: 207-230-1007
  • Fax: 207-230-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number1822
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: