Provider Demographics
NPI:1306078969
Name:JENSEN, KATHLEEN ANN (RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:MCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:621 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1960
Mailing Address - Country:US
Mailing Address - Phone:320-287-2585
Mailing Address - Fax:320-589-7433
Practice Address - Street 1:621 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1960
Practice Address - Country:US
Practice Address - Phone:320-287-2585
Practice Address - Fax:320-589-7433
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR127434-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR127434-3OtherRN LICENSE