Provider Demographics
NPI:1144529496
Name:JENSON, SHANNON LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:JENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8900 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3919
Mailing Address - Country:US
Mailing Address - Phone:952-935-8407
Mailing Address - Fax:
Practice Address - Street 1:8900 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-3919
Practice Address - Country:US
Practice Address - Phone:952-935-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005843363A00000X
NH0838363A00000X
MN12417363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant