Healthcare Provider Details

I. General information

NPI: 1063985307
Provider Name (Legal Business Name): KAREN E JENSEN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 FARM LAKE RD
CAROLINA SHORES NC
28467-3082
US

IV. Provider business mailing address

153 FARM LAKE RD
CAROLINA SHORES NC
28467-3082
US

V. Phone/Fax

Practice location:
  • Phone: 908-246-8904
  • Fax:
Mailing address:
  • Phone: 908-246-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberA-9217
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: