MEDICARE: RACHAE A 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	001853	IA

General Provider Information

NPI Number	:	1407024037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAE A JENSEN PA-C

Provider Business Mailing Address
First Line	:	3500 MOUNT VERNON RD SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-3864
Country	:	US
Telephone Number	:	319-363-0474
Fax Number	:	319-363-2170

Provider Business Practice Location Address
First Line	:	3500 MOUNT VERNON RD SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-3864
Country	:	US
Telephone Number	:	319-363-0474
Fax Number	:	319-363-2170

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

Provider Enumeration Date	:	02/17/2008
Last Update Date	:	02/17/2008

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