Basic Information
| Provider Information | |||||||||
| NPI: | 1154405959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | CHERI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 670 | ||||||||
| Address2: | |||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3088652141 | ||||||||
| FaxNumber: | 3082347582 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 WEST 33RTD STREET | ||||||||
| Address2: | |||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3088652141 | ||||||||
| FaxNumber: | 3082347582 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 15375 | NE | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 47064194516 | 05 | NE | MEDICAID | 32076 | 01 | BCBS | OTHER |