Individual
JOHANNA M JENSEN
Active
Individual
JOHANNA M JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M9011
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147359
REGENCE BLUE SHIELD OF ID
ID
01
—
0638840001
DMERC
ID
01
—
70862
BLUE CROSS OF IDAHO
ID
05
—
806911600
—
ID
Enumeration date
03/14/2006
Last updated
05/01/2012
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