Healthcare Provider Details

I. General information

NPI: 1093046138
Provider Name (Legal Business Name): GWEN MARIE JENSEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HIGHLAND AVE
HANOVER PA
17331-2297
US

IV. Provider business mailing address

250 FAME AVE STE 210
HANOVER PA
17331-1587
US

V. Phone/Fax

Practice location:
  • Phone: 717-637-3711
  • Fax:
Mailing address:
  • Phone: 717-632-9955
  • Fax: 717-632-9893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4054488
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN336469L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: