=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396117438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENSON JAMES HAGEN N.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2015
-----------------------------------------------------
Last Update Date | 10/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12407 235TH PL NE
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98053-5616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-356-8284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12407 235TH PL NE
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98053-5616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-356-8284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------