Provider Demographics
NPI:1235402470
Name:JORGENSEN, ERIN ANNE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ANNE
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CHASE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-1143
Mailing Address - Country:US
Mailing Address - Phone:608-632-3254
Mailing Address - Fax:
Practice Address - Street 1:305 CHASE ST APT 6
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1143
Practice Address - Country:US
Practice Address - Phone:608-632-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula