Provider Demographics
NPI:1043227317
Name:JORGENSON, BETH CHRISTINE (RN)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:CHRISTINE
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SMITH AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2572
Mailing Address - Country:US
Mailing Address - Phone:651-726-2719
Mailing Address - Fax:651-233-5088
Practice Address - Street 1:255 SMITH AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2572
Practice Address - Country:US
Practice Address - Phone:651-726-2719
Practice Address - Fax:651-233-5088
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR104845-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse