Individual
BLAINE S. JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1134 W HWY 60, SUPERIOR, AZ 85273-2647
(520) 689-2423
(520) 689-5237
Mailing address
1134 W HWY 60, SUPERIOR, AZ 85173-2647
(520) 689-2423
(928) 425-3859
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2322
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507147
—
AZ
01
—
Z69075
PTAN
AZ
Enumeration date
08/31/2006
Last updated
12/11/2014
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