Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0102205792 | VA |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 12884 | SD |
NPI | 1184128175 |
---|---|
Provider Name | Mr. Zachariah Jensen |
First Address | Sioux Falls, SD 57108-2988 |
Second Address | Sioux Falls, SD 57108-2988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2018 |
Last Update Date | 18/08/2021 |