Healthcare Provider Details

I. General information

NPI: 1386785343
Provider Name (Legal Business Name): LYNN JENSEN RN, MS, GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 S BUTTERFIELD WAY
GREENFIELD WI
53221-3249
US

IV. Provider business mailing address

5345 S BUTTERFIELD WAY
GREENFIELD WI
53221-3249
US

V. Phone/Fax

Practice location:
  • Phone: 414-763-4195
  • Fax:
Mailing address:
  • Phone: 414-763-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61743-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00094632
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number2548-033
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberAP30002498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: