| Doctor Name: | JENNA JENSEN |
| NPI Number: | 1194095570 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 23739 A |
| Business Practice Address: | General Delivery 551 Highland Dr/ Box 815 Arco, ID - 832139999 |
| Business Phone Number: | 2085278206 |
| Business Fax Number: | |
| Mailing Address: | Po Box 815, Lost Rivers Clinic ARCO |
| State: | ID |
| Postal Code: | 832130815 |
| Phone Number: | 2085278206 |
| Fax Number: | 2085273616 |
| NPI Enumeration Date: | 01/03/2012 |
| NPI Last Update Date: | 01/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 23739 A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |