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NPI Code Detail

MEDICARE: SHANNON LEIGH JENSON PA-C

MEDICARE: SHANNON LEIGH JENSON 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
1363A00000XPhysician AssistantC0005843MD
2363A00000XPhysician Assistant0838NH
3363A00000XPhysician Assistant12417MN

General Provider Information

NPI Number : 1144529496
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON LEIGH JENSON PA-C
Provider Business Mailing Address
First Line : 4656 EXCELSIOR BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-4938
Country : US
Telephone Number : 952-929-0140
Fax Number : 952-926-1055
Provider Business Practice Location Address
First Line : 4656 EXCELSIOR BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-4938
Country : US
Telephone Number : 952-929-0140
Fax Number : 952-926-1055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2011
Last Update Date : 10/28/2025

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Directions to “ SHANNON LEIGH JENSON PA-C” Practice Location

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