MEDICARE: JENNIFER HENSELER LVN

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	164X00000X	Licensed Vocational Nurse	263411	CA

General Provider Information

NPI Number	:	1609643840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HENSELER LVN

Provider Business Mailing Address
First Line	:	2085 RUSTIN AVE # 3
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2498
Country	:	US
Telephone Number	:	951-955-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	2085 RUSTIN AVE # 3
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2498
Country	:	US
Telephone Number	:	951-955-2309
Fax Number	:

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

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	04/13/2026

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