Jensen, Johanna M

Jensen, Johanna M is an individual health care provider with primary practice located at 1615 12Th Ave Rd Ste A, Nampa ID 83686-7713. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Jensen, Johanna M can be contacted via phone (208) 467-4406.

Contact Information

Primary practice address
1615 12Th Ave Rd Ste A Nampa ID 83686-7713
Phone: (208) 467-4406
Fax: (208) 467-4450
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X M9011 Idaho

Profile Details

NPI number 1770552846
LBN Legal business name Jensen, Johanna M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated May 1st, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770552846 NPPES
Idaho Other 0638840001 DMERC
Idaho MEDICAID 806911600 DMERC
Idaho Other 000010147359 DMERC
Idaho Other 70862 DMERC

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