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Individual
JODY MICHELLE JENSEN
Active
Individual
JODY MICHELLE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
19909
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12287854
CAQH PROVIDER NUMBER
CA
01
—
19909
PHYSICIAN ASSISTANT COMMITTEE LICENSE NUMBER
CA
Enumeration date
03/25/2009
Last updated
08/13/2012
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