Healthcare Provider Details

I. General information

NPI: 1649614389
Provider Name (Legal Business Name): ALAN D JENSEN MD P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8761 W CENTER RD STE B
OMAHA NE
68124-2166
US

IV. Provider business mailing address

8761 W CENTER RD STE B
OMAHA NE
68124-2166
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-6060
  • Fax: 402-398-0336
Mailing address:
  • Phone: 402-397-6060
  • Fax: 402-398-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number17820
License Number StateNE

VIII. Authorized Official

Name: DR. ALAN DEAN JENSEN
Title or Position: PREIDENT
Credential: MD
Phone: 402-397-6060