Healthcare Provider Details

I. General information

NPI: 1760067813
Provider Name (Legal Business Name): REBECCA JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N 1100 E STE C
AMERICAN FORK UT
84003-2918
US

IV. Provider business mailing address

916 S 800 EAST CIR
ST GEORGE UT
84790-5613
US

V. Phone/Fax

Practice location:
  • Phone: 801-874-1945
  • Fax:
Mailing address:
  • Phone: 435-669-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: