=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871922666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC JAMES JENSEN CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2013
-----------------------------------------------------
Last Update Date | 06/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2104 NORTHDALE BLVD NW STE 220
-----------------------------------------------------
City | COON RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55433-3046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-537-6000
-----------------------------------------------------
Fax | 763-537-6666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8092 W PARADISE LN APT 1001
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85382-4977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-275-0924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | CRNA0993
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 1925
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | R037114
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------