Healthcare Provider Details

I. General information

NPI: 1568305035
Provider Name (Legal Business Name): FIA JENSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E37
HERMISTON OR
97838-8604
US

IV. Provider business mailing address

PO BOX 1753
PENDLETON OR
97801-0590
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-5305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number200941157RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: