Healthcare Provider Details

I. General information

NPI: 1477326452
Provider Name (Legal Business Name): ANDREW JENSEN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HILYARD ST
EUGENE OR
97401-3501
US

IV. Provider business mailing address

1255 HILYARD ST
EUGENE OR
97401-3501
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-6929
  • Fax:
Mailing address:
  • Phone: 541-686-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number201142273RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: