1417277294 NPI number — FAIRVIEW EXPRESS CARE

Table of content: DR. JENNIFER LEE JENSEN O.D. (NPI 1548487333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417277294 NPI number — FAIRVIEW EXPRESS CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW EXPRESS CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417277294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 UNIVERSITY AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104-3727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-672-6724
Provider Business Mailing Address Fax Number:
612-884-3592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10961 CLUB WEST PKWY
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55449-5866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-528-2992
Provider Business Practice Location Address Fax Number:
763-528-2951
Provider Enumeration Date:
06/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RING
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
V
Authorized Official Title or Position:
SYS DIR GOVT REIMB & NETWK REL
Authorized Official Telephone Number:
612-672-6740

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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