Healthcare Provider Details

I. General information

NPI: 1134557093
Provider Name (Legal Business Name): TAMI LYNN JORGENSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 MIDDLETON PIKE APT# D
LUCKEY OH
43443-9701
US

IV. Provider business mailing address

P.O.BOX 388 5 MAIN ST
LUCKEY OH
43443
US

V. Phone/Fax

Practice location:
  • Phone: 419-343-5841
  • Fax:
Mailing address:
  • Phone: 419-343-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN348553
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: