Provider Demographics
NPI:1174991384
Name:JENSEN, SUSAN B (DNP, CPNP-PC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 DENNIS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7287
Mailing Address - Country:US
Mailing Address - Phone:910-333-0617
Mailing Address - Fax:
Practice Address - Street 1:900 DENNIS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7287
Practice Address - Country:US
Practice Address - Phone:910-333-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001611363LP0200X
NC285575363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics