Healthcare Provider Details

I. General information

NPI: 1841594058
Provider Name (Legal Business Name): JENNIFER LYNN JERSAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N LINCOLN ST
GREENSBURG IN
47240-1348
US

IV. Provider business mailing address

718 N LINCOLN ST
GREENSBURG IN
47240-1348
US

V. Phone/Fax

Practice location:
  • Phone: 812-222-3627
  • Fax: 812-663-1155
Mailing address:
  • Phone: 812-222-3627
  • Fax: 812-663-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003497A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: