Individual
MRS. MELISSA MARIE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8905 W LINCOLN AVE, WEST ALLIS, WI 53227-2468
(414) 328-6000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2511
WI
363AM0700X
Medical Physician Assistant
2511-23
WI
363AM0700X
Medical Physician Assistant
5601006202
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100006694
—
WI
01
—
5390159
BCBS
MI
Enumeration date
10/02/2009
Last updated
08/12/2024
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