Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 225100000X | CO |
Y | 225100000X | Physical Therapist | 3597-024 | WI |
N | 2251H1200X | Hand | 3597024 | WI |
NPI | 1982681862 |
---|---|
Provider Name | Karen Louise Jensen |
First Address | Appleton, WI 54913-8284 |
Second Address | Appleton, WI 54913-8284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 31/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36166800 | (05) | WI |
98006274 | (05) | CO |