Basic Information
| Provider Information | |||||||||
| NPI: | 1689676736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 JOHNSON RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439522356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402648600 | ||||||||
| FaxNumber: | 7403460298 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 JOHNSON RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439522356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402648760 | ||||||||
| FaxNumber: | 7403460298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 05/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34005154 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 34005154 | 01 | OH | STATE LICENSE NUMBER | OTHER | 207VX0000X | 01 | OH | TAXONOMY NUMBER | OTHER |