Provider Demographics
NPI:1912087867
Name:JENSEN, LISA K (FNP CNM)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:JENSEN
Suffix:
Gender:F
Credentials:FNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 ASH HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:NH
Mailing Address - Zip Code:03585
Mailing Address - Country:US
Mailing Address - Phone:603-838-6130
Mailing Address - Fax:
Practice Address - Street 1:331 UPPER PLAIN
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033
Practice Address - Country:US
Practice Address - Phone:802-222-4722
Practice Address - Fax:802-222-4709
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0256212301176B00000X
VT1010025554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005029Medicaid
VT1003832Medicaid
NH30005029Medicaid