=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154562221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE M. JENSEN A,P
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2009
-----------------------------------------------------
Last Update Date | 03/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6404 MANATEE AVE W SUITE I
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34209-2379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-773-8410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6404 MANATEE AVE W SUITE I
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34209-2379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-773-8410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP2540
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------