Healthcare Provider Details

I. General information

NPI: 1669432340
Provider Name (Legal Business Name): ROBERTA MAE JENSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 DOUGLAS ST
RHINELANDER WI
54501-2419
US

IV. Provider business mailing address

424 DOUGLAS ST
RHINELANDER WI
54501-2419
US

V. Phone/Fax

Practice location:
  • Phone: 715-362-5244
  • Fax:
Mailing address:
  • Phone: 715-362-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: