Healthcare Provider Details

I. General information

NPI: 1457322703
Provider Name (Legal Business Name): MICHAEL J JENSEN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CROSS ST SE
AUBURN WA
98002-5406
US

IV. Provider business mailing address

202 CROSS ST SE
AUBURN WA
98002-5406
US

V. Phone/Fax

Practice location:
  • Phone: 253-876-8111
  • Fax:
Mailing address:
  • Phone: 253-876-8111
  • Fax: 253-876-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1469
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60055107
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60055107
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: