Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 257422 | MA |
N | 208000000X | Pediatrician | 257422 | MA |
NPI | 1093979403 |
---|---|
Provider Name | Dr. Jocelyn R Jensen |
First Address | Springfield, MA 01199-1619 |
Second Address | Springfield, MA 01199-1619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2008 |
Last Update Date | 22/07/2014 |