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General NPI Number Information
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NPI Number | 1326672072
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Entity Type | Individual
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Provider Name | RACHEL LYN JENSEN
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Gender | Female
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 152 PIONEER LN STE A
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City | BISHOP
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State | CA
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Zip | 93514-2563
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Country | US
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Telephone | 760-873-2605
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Fax | 760-873-2769
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Provider Business Mailing Address
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Address Line | 152 PIONEER LN STE A
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City | BISHOP
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State | CA
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Zip | 93514-2563
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Country | US
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Telephone | 760-873-2605
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Fax | 760-873-2769
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000001737
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License Number State | UT
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