Provider Demographics
NPI:1871922666
Name:JENSEN, ERIC JAMES (CRNA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:JENSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8092 W PARADISE LN APT 1001
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4977
Mailing Address - Country:US
Mailing Address - Phone:605-275-0924
Mailing Address - Fax:
Practice Address - Street 1:8092 W PARADISE LN APT 1001
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-4977
Practice Address - Country:US
Practice Address - Phone:605-275-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0993367500000X
SDR037114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse