Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | RN60195082 | WA |
NPI | 1013437623 |
---|---|
Provider Name | Megan Jensen |
First Address | Fort Stewart, GA 31314-5641 |
Second Address | Fort Stewart, GA 31314-5641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2017 |
Last Update Date | 24/06/2017 |