Provider Demographics
NPI:1114677614
Name:JORGENSEN, ABIGAIL (CD-L(PRODOULA))
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:CD-L(PRODOULA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 SORIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2125
Mailing Address - Country:US
Mailing Address - Phone:763-242-8148
Mailing Address - Fax:
Practice Address - Street 1:1141 SORIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2125
Practice Address - Country:US
Practice Address - Phone:763-242-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula