MEDICARE: DR. JULIA MARIE JENSEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L2954	TX
2	207Q00000X	Family Medicine Physician	19888	MS

General Provider Information

NPI Number	:	1003819509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA MARIE JENSEN DO

Provider Business Mailing Address
First Line	:	211 16TH AVE N
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-4058
Country	:	US
Telephone Number	:	208-467-4431
Fax Number	:	208-467-7684

Provider Business Practice Location Address
First Line	:	223 16TH AVE N
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-4058
Country	:	US
Telephone Number	:	208-466-7869
Fax Number	:	208-466-5359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/31/2015

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