Healthcare Provider Details

I. General information

NPI: 1295462828
Provider Name (Legal Business Name): KATHERINE JENSEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BELLWETHER WAY STE 223
BELLINGHAM WA
98225-2914
US

IV. Provider business mailing address

4111 NE MARTIN LUTHER KING JR BLVD APT 313
PORTLAND OR
97211-3506
US

V. Phone/Fax

Practice location:
  • Phone: 360-230-8202
  • Fax:
Mailing address:
  • Phone: 510-552-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: