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General NPI Number Information
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NPI Number | 1811730286
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE JENSEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/14/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 6700 MERCY RD STE 109
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City | OMAHA
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State | NE
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Zip | 68106-2629
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Country | US
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Telephone | 402-354-2273
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Fax | 402-354-6680
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Provider Business Mailing Address
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Address Line | PO BOX 3755
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City | OMAHA
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State | NE
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Zip | 68103-0755
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Country | US
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Telephone | 402-354-4230
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 126593
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3130
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License Number State | NE
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