Individual
MS. EMILY ELISE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
391 S BOLINGBROOK DR, BOLINGBROOK, IL 60440-3411
(630) 226-1006
Mailing address
17735 S WILLIAMSBURG DR, PLAINFIELD, IL 60586-8636
(630) 643-3886
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085004165
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085004165
STATE MEDICAL LICENSE
IL
Enumeration date
10/13/2011
Last updated
12/27/2013
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