Provider Demographics
NPI:1083987804
Name:JORGENSEN, AMY L (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:110 N 29TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4424
Mailing Address - Country:US
Mailing Address - Phone:402-844-8121
Mailing Address - Fax:402-844-8122
Practice Address - Street 1:301 N 27TH ST
Practice Address - Street 2:STE 2
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4401
Practice Address - Country:US
Practice Address - Phone:402-844-8291
Practice Address - Fax:402-844-8292
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2017-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE2295247100000X
NE1640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist