Individual
SUSAN DANETTE JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TT47289
Contact information
Practice address
4110 S 10TH AVE, CALDWELL, ID 83605-5706
(208) 402-0154
Mailing address
4110 S 10TH AVE, CALDWELL, ID 83605-5706
(208) 402-0154
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
TT47289
ID
Other
Enumeration date
03/27/2022
Last updated
03/27/2022
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