1629880265 NPI number — MRS. TIFFANY LYNN JENSEN MHA, MBA

Table of content: MRS. TIFFANY LYNN JENSEN MHA, MBA (NPI 1629880265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629880265 NPI number — MRS. TIFFANY LYNN JENSEN MHA, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENSEN
Provider First Name:
TIFFANY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MHA, MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1629880265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 MOYERS GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAPWALLOPEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18660-2051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-294-2095
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 E 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-294-2095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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