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NPI Code Detail

MEDICARE: KATHERINE MARIE JENSEN RN

MEDICARE: KATHERINE MARIE JENSEN RN
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
1101YA0400XAddiction (Substance Use Disorder) Counselor304935MN

General Provider Information

NPI Number : 1023325685
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE MARIE JENSEN RN
Provider Business Mailing Address
First Line : 2236 MARSHALL AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-5799
Country : US
Telephone Number : 651-659-0208
Fax Number : 651-659-0161
Provider Business Practice Location Address
First Line : 8590 EDINBURGH CENTER DR
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-3723
Country : US
Telephone Number : 763-425-5959
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2010
Last Update Date : 05/24/2024

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