Provider Demographics
NPI:1053860205
Name:JORGENSEN, DANA LYNN
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 EAST AVE S
Mailing Address - Street 2:APT. 225
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7247
Mailing Address - Country:US
Mailing Address - Phone:262-902-8692
Mailing Address - Fax:
Practice Address - Street 1:3335 EAST AVE S
Practice Address - Street 2:APT. 225
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7247
Practice Address - Country:US
Practice Address - Phone:262-902-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program