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General NPI Number Information
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NPI Number | 1669737300
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Entity Type | Individual
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Provider Name | JODY LYNN JENSON MSN,APRN,PMHNP
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Gender | Male
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 49725 COUNTY 83
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City | STAPLES
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State | MN
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Zip | 56479-5280
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Country | US
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Telephone | 218-894-8854
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Fax | 218-894-8867
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Provider Business Mailing Address
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Address Line | 49725 COUNTY 83
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City | STAPLES
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State | MN
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Zip | 56479-5280
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Country | US
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Telephone | 218-894-8854
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Fax | 218-894-8867
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP-1189A
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License Number State | ID
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