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NPI Code Detail

MEDICARE: OLIVIA JENSEN BSN, RN

MEDICARE: OLIVIA JENSEN BSN, RN
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
1163WC0200XCritical Care Medicine Registered Nurse857117-01NY

General Provider Information

NPI Number : 1790676104
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA JENSEN BSN, RN
Provider Business Mailing Address
First Line : 3435 MAIN ST
Second Line :
City : BUFFALO
State : NY
Zip : 14214-3099
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 326 WENDE HALL
Second Line :
City : BUFFALO
State : NY
Zip : 14214-8013
Country : US
Telephone Number : 716-829-3740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2025
Last Update Date : 07/14/2025

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