Provider Demographics
NPI:1902603863
Name:JENSEN, EARLEEN FAYE
Entity type:Individual
Prefix:PROF
First Name:EARLEEN
Middle Name:FAYE
Last Name:JENSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51891 864TH RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL
Mailing Address - State:NE
Mailing Address - Zip Code:68773-5056
Mailing Address - Country:US
Mailing Address - Phone:402-929-3471
Mailing Address - Fax:
Practice Address - Street 1:203 FREMONT ST
Practice Address - Street 2:
Practice Address - City:ROYAL
Practice Address - State:NE
Practice Address - Zip Code:68773-5061
Practice Address - Country:US
Practice Address - Phone:402-929-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant