Healthcare Provider Details

I. General information

NPI: 1023325685
Provider Name (Legal Business Name): KATHERINE MARIE JENSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 05/24/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8590 EDINBURGH CENTER DR
BROOKLYN PARK MN
55443-3723
US

IV. Provider business mailing address

2236 MARSHALL AVE
SAINT PAUL MN
55104-5799
US

V. Phone/Fax

Practice location:
  • Phone: 763-425-5959
  • Fax:
Mailing address:
  • Phone: 651-659-0208
  • Fax: 651-659-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304935
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: