Individual
MRS. KATIE SULLIVAN JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
111 S FRONT ST, HARRISBURG, PA 17101-2010
(717) 782-5118
(717) 782-5854
Mailing address
409 S 2ND ST, SUITE 2F, HARRISBURG, PA 17104-1612
(717) 782-3282
(717) 231-8964
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
174761-30
WI
163W00000X
Registered Nurse
RN592667
PA
367500000X
Certified Registered Nurse Anesthetist
R162842
MD
367500000X
Certified Registered Nurse Anesthetist
Primary
RN592667
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102912432
—
PA
Enumeration date
05/24/2011
Last updated
01/19/2021
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