Individual
STEPHANIE L JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LRD
Contact information
Practice address
401 N 9TH ST, BISMARCK, ND 58501-4506
(701) 712-4500
Mailing address
401 N 9TH ST, BISMARCK, ND 58501-4506
(701) 712-4940
(701) 712-4159
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1256
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45-0311334
TAX IDENTIFICATION NUMBER
ND
Enumeration date
09/18/2020
Last updated
06/14/2023
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