Healthcare Provider Details

I. General information

NPI: 1073120606
Provider Name (Legal Business Name): JENSEN EYRE CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S 500 E STE 202
SALT LAKE CITY UT
84102-1094
US

IV. Provider business mailing address

34 S 500 E STE 202
SALT LAKE CITY UT
84102-1094
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-2011
  • Fax: 801-582-2011
Mailing address:
  • Phone: 801-582-2011
  • Fax: 801-582-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number33951
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number33951
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number33951
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: