Provider Demographics
NPI:1699433144
Name:JENSON, LAURIE (RN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:JENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:ROZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:319 MERTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1814
Mailing Address - Country:US
Mailing Address - Phone:262-490-7857
Mailing Address - Fax:
Practice Address - Street 1:319 MERTON AVE
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1814
Practice Address - Country:US
Practice Address - Phone:262-490-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI112789-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse