Provider Demographics
NPI:1225446180
Name:JORGENSEN, JENNIFER SPEICHER (DNP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SPEICHER
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 LOCUST ST N STE 700
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4164
Mailing Address - Country:US
Mailing Address - Phone:208-595-5095
Mailing Address - Fax:208-595-5258
Practice Address - Street 1:1502 LOCUST ST N STE 700
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4164
Practice Address - Country:US
Practice Address - Phone:208-595-5095
Practice Address - Fax:208-595-5258
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1462A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1225446180Medicaid
ID20005467Medicare PIN