Healthcare Provider Details

I. General information

NPI: 1861999435
Provider Name (Legal Business Name): ELYSE JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WOODBINE LN
DANVILLE PA
17821-8029
US

IV. Provider business mailing address

GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVENUE
DANVILLE PA
17822-0001
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6700
  • Fax: 570-214-6700
Mailing address:
  • Phone: 570-271-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD477490
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: