Provider Demographics
NPI:1023613213
Name:JENSEN, AMBER ANN
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 CEDAR RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8462
Mailing Address - Country:US
Mailing Address - Phone:530-207-0297
Mailing Address - Fax:
Practice Address - Street 1:5012 CEDAR RAVINE RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8462
Practice Address - Country:US
Practice Address - Phone:530-207-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator