Healthcare Provider Details

I. General information

NPI: 1871922666
Provider Name (Legal Business Name): ERIC JAMES JENSEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 NORTHDALE BLVD NW STE 220
COON RAPIDS MN
55433-3046
US

IV. Provider business mailing address

8092 W PARADISE LN APT 1001
PEORIA AZ
85382-4977
US

V. Phone/Fax

Practice location:
  • Phone: 763-537-6000
  • Fax: 763-537-6666
Mailing address:
  • Phone: 605-275-0924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0993
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1925
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR037114
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: