Healthcare Provider Details

I. General information

NPI: 1619208444
Provider Name (Legal Business Name): SHAWN JENSEN R.N., CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWN WENTZ

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 S MOORLAND RD STE 250
NEW BERLIN WI
53151-7494
US

IV. Provider business mailing address

1320 CARDINAL DR
OCONOMOWOC WI
53066-2383
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-6020
  • Fax: 262-789-6025
Mailing address:
  • Phone: 262-893-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number161673-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number13131-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: