Provider Demographics
NPI:1093579740
Name:JORGENSEN, BRYNN JENKINS (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRYNN
Middle Name:JENKINS
Last Name:JORGENSEN
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 1:15230 S REBEL LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1220
Mailing Address - Country:US
Mailing Address - Phone:801-696-9459
Mailing Address - Fax:
Practice Address - Street 1:15230 S REBEL LN
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-1220
Practice Address - Country:US
Practice Address - Phone:801-696-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9043364-3102163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care