Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 15375 | NE |
NPI | 1154405959 |
---|---|
Provider Name | Cheri L Jensen |
First Address | Kearney, NE 68848 |
Second Address | Kearney, NE 68845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32076 | BCBS (01) | |
47064194516 | (05) | NE |
B90956 | (02) |