Provider Demographics
NPI:1124214192
Name:JORGENSEN, ANNA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-0963
Mailing Address - Country:US
Mailing Address - Phone:817-681-9563
Mailing Address - Fax:
Practice Address - Street 1:436 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-2608
Practice Address - Country:US
Practice Address - Phone:817-681-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198367164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198367OtherLVN