Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | ME 63338 | FL |
NPI | 1528020070 |
---|---|
Provider Name | Susan Jensen |
First Address | Salisbury, NC 28144-2515 |
Second Address | Salisbury, NC 28144-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F13109 | (02) | FL |