MEDICARE: CHARMAINE B JENSEN D.O.

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	2086S0122X	Plastic and Reconstructive Surgery Physician	1822	ME

General Provider Information

NPI Number	:	1215010889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARMAINE B JENSEN D.O.

Provider Business Mailing Address
First Line	:	2239 ATLANTIC HWY
Second Line	:
City	:	LINCOLNVILLE
State	:	ME
Zip	:	04849-5310
Country	:	US
Telephone Number	:	207-230-1007
Fax Number	:	207-230-1008

Provider Business Practice Location Address
First Line	:	2239 ATLANTIC HWY
Second Line	:
City	:	LINCOLNVILLE
State	:	ME
Zip	:	04849-5310
Country	:	US
Telephone Number	:	207-230-1007
Fax Number	:	207-230-1008

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	01/28/2013

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