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NPI Code Detail

MEDICARE: ABIGAIL JORGENSEN CD-L(PRODOULA)

MEDICARE: ABIGAIL JORGENSEN CD-L(PRODOULA)
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1374J00000XDoula

General Provider Information

NPI Number : 1114677614
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL JORGENSEN CD-L(PRODOULA)
Provider Business Mailing Address
First Line : 1141 SORIN ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-2125
Country : US
Telephone Number : 763-242-8148
Fax Number :
Provider Business Practice Location Address
First Line : 1141 SORIN ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-2125
Country : US
Telephone Number : 763-242-8148
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2022
Last Update Date : 03/27/2022

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Directions to “ ABIGAIL JORGENSEN CD-L(PRODOULA)” Practice Location

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