Doctor Name: | DR. TRACI E. JENSEN |
NPI Number: | 1053595041 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | R927 |
Business Practice Address: | 6320 W Union Hills Dr Building B Suite 2300 Glendale, AZ - 853081096 |
Business Phone Number: | 6235619113 |
Business Fax Number: | |
Mailing Address: | 2500 W Utopia Rd, Ste. 100 PHOENIX |
State: | AZ |
Postal Code: | 850274171 |
Phone Number: | 6022146148 |
Fax Number: | 6022146149 |
NPI Enumeration Date: | 12/26/2007 |
NPI Last Update Date: | 09/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | R927 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |