Healthcare Provider Details

I. General information

NPI: 1679983639
Provider Name (Legal Business Name): TRICIA B JENSEN RN-CDE, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD SUITE 509
OMAHA NE
68124-2372
US

IV. Provider business mailing address

PO BOX 642117
OMAHA NE
68164-8117
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-6255
  • Fax: 402-829-8513
Mailing address:
  • Phone: 402-398-6255
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number59626
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: