Provider Demographics
NPI:1629015722
Name:JENSEN, SHEILA (CRNA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 E BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-4510
Mailing Address - Country:US
Mailing Address - Phone:907-357-8124
Mailing Address - Fax:
Practice Address - Street 1:1600 A ST STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5147
Practice Address - Country:US
Practice Address - Phone:907-272-2423
Practice Address - Fax:907-272-2428
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK195367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK193975000OtherACA FED DOL#
WAP00435944OtherRR MEDICARE
AK020257499OtherACA ENERGY EMP GROUP#
AKCI9459OtherACA GROUP RR MCR #
AKP00098550OtherRR MEDICARE
AK1030921Medicaid
AKK151896OtherMEDICARE AK
AK151896Medicare PIN
WAG8865523Medicare PIN
WAP00435944OtherRR MEDICARE
AK150657Medicare ID - Type UnspecifiedACA GROUP MCR#
WAG8865524Medicare PIN
AKCI9459OtherACA GROUP RR MCR #
AKMDG417Medicaid
WAG8865527Medicare PIN
WAG8865526Medicare PIN