Healthcare Provider Details

I. General information

NPI: 1396571972
Provider Name (Legal Business Name): GAIL ANN JENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 RAVEN LOOP
FOLEY MN
56329-9022
US

IV. Provider business mailing address

10425 RAVEN LOOP
FOLEY MN
56329-9022
US

V. Phone/Fax

Practice location:
  • Phone: 320-250-9630
  • Fax:
Mailing address:
  • Phone: 320-250-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR-125017-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: