Provider Information for 1609298991
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ROBERT JOSIAH JENSEN
Sex: Male
NPI: 1609298991
Last Updated: 2016-07-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1609298991 | ||||||||
| Enumeration Date | 2014-01-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 18806 58TH ST E LAKE TAPPS, WA 98391-8805 United States Phone: 253-830-4119 | Fax: | ||||||||
| Primary Practice Address | 15324 MAIN ST E SUMNER, WA 98390-2698 United States Phone: 253-830-4119 | Fax: | ||||||||
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