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General NPI Number Information
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NPI Number | 1578729901
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Entity Type | Organization
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Legal Business Name | CANDICE JENSEN MD PLLC
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 2503 S AVE A SUITE 3
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City | YUMA
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State | AZ
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Zip | 85364-7173
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Country | US
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Telephone | 928-344-3250
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Fax | 928-344-3253
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Provider Business Mailing Address
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Address Line | 2503 S AVE A SUITE 3
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City | YUMA
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State | AZ
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Zip | 85364-7173
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Country | US
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Telephone | 928-344-3250
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Fax | 928-344-3253
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | CANDICE MICHELLE JENSEN
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Credential | MD
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Telephone | 928-344-3250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 38206
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License Number State | AZ
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