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Individual

LISA M JENSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
12555 UNIVERSITY AVE NW, BLAINE, MN 55434
(763) 506-6729
Mailing address
16317 WINTERGREEN ST NW, ANDOVER, MN 55304-7734
(763) 783-0849

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1453
MN

Other

Enumeration date
04/12/2007
Last updated
07/08/2007
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