Provider Demographics
NPI:1962611194
Name:JENSEN, GWENNETH ANNE (RN)
Entity type:Individual
Prefix:MS
First Name:GWENNETH
Middle Name:ANNE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:SD
Mailing Address - Zip Code:57036-0413
Mailing Address - Country:US
Mailing Address - Phone:605-238-5363
Mailing Address - Fax:
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD RN R016765163W00000X
SDSD CNS CS004058163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WG0600XNursing Service ProvidersRegistered NurseGerontology