MEDICARE: WILLIAM J JENSEN PA-C

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	363AM0700X	Medical Physician Assistant	PA-618	ID

General Provider Information

NPI Number	:	1093805467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J JENSEN PA-C

Provider Business Mailing Address
First Line	:	1828 S MILLENIUM WAY STE 300
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-5036
Country	:	US
Telephone Number	:	208-895-8775
Fax Number	:	208-895-1775

Provider Business Practice Location Address
First Line	:	1828 S MILLENIUM WAY STE 300
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-5036
Country	:	US
Telephone Number	:	208-895-8775
Fax Number	:	208-895-1775

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	02/05/2026

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