Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 19888 | MS |
N | 207Q00000X | Family Doctor | L2954 | TX |
NPI | 1003819509 |
---|---|
Provider Name | Dr. Julia Marie Jensen |
First Address | Nampa, ID 83687-4058 |
Second Address | Nampa, ID 83687-4058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 31/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H71729 | (02) | TX |