Provider Demographics
NPI:1578856878
Name:JENSON, JEANNETTE JUSTINE (LPN)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:JUSTINE
Last Name:JENSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:JUSTINE
Other - Last Name:EGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2504 W GRANT ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2535
Mailing Address - Country:US
Mailing Address - Phone:414-324-6769
Mailing Address - Fax:
Practice Address - Street 1:2504 W GRANT ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2535
Practice Address - Country:US
Practice Address - Phone:414-324-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29733-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse