Healthcare Provider Details

I. General information

NPI: 1306014584
Provider Name (Legal Business Name): MARTHA JEANNE JENSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 N WASHINGTON AVE GMHS SMCO MEDICAL DEPT
SAGINAW MI
48601-1211
US

IV. Provider business mailing address

8825 IROQUOIS RD
SAINT HELEN MI
48656-9746
US

V. Phone/Fax

Practice location:
  • Phone: 989-757-0518
  • Fax: 989-757-1597
Mailing address:
  • Phone: 90-389-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number4704101301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: