Healthcare Provider Details

I. General information

NPI: 1871553255
Provider Name (Legal Business Name): CYNTHIA L JENSEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 OSCEOLA ST
LAURIUM MI
49913-2134
US

IV. Provider business mailing address

1140 N STATE ST
SAINT IGNACE MI
49781-1048
US

V. Phone/Fax

Practice location:
  • Phone: 906-337-6560
  • Fax: 906-337-6582
Mailing address:
  • Phone: 906-643-0405
  • Fax: 906-643-1553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number16864
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number5101014312
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: