Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 6206339-4405 | UT |
NPI | 1235784562 |
---|---|
Provider Name | Angie May Jensen |
First Address | St George, UT 84790-2123 |
Second Address | St George, UT 84790-2123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2019 |
Last Update Date | 05/08/2019 |