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Individual

JOHANNA M JENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1615 12TH AVE RD, STE A, NAMPA, ID 83686-7713
(208) 467-4406
(208) 467-4450
Mailing address
1615 12TH AVE RD, STE A, NAMPA, ID 83686-7713
(208) 467-4406
(208) 467-4450

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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