Individual
MRS. BROOKE A. JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
99305 HICKORY DR, FORT DRUM, NY 13603-3416
(315) 681-6960
Mailing address
99305 HICKORY DR, FORT DRUM, NY 13603-3416
(315) 681-6960
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
1318673
NY
Other
Enumeration date
05/30/2012
Last updated
05/30/2012
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