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NPI Code Detail

MEDICARE: MRS. AYDIN MERIBA JENSEN

MEDICARE: MRS. AYDIN MERIBA JENSEN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1811700511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AYDIN MERIBA JENSEN
Provider Business Mailing Address
First Line : 295 S CHIPETA WAY STE 22
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1234
Country : US
Telephone Number : 435-496-1048
Fax Number :
Provider Business Practice Location Address
First Line : 295 S CHIPETA WAY STE 22
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1234
Country : US
Telephone Number : 435-496-1048
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2025
Last Update Date : 03/22/2025

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