Provider Demographics
NPI:1366468811
Name:JORGENSEN, SANDRA (CNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16313 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1250
Mailing Address - Country:US
Mailing Address - Phone:216-529-9727
Mailing Address - Fax:
Practice Address - Street 1:16313 LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-1250
Practice Address - Country:US
Practice Address - Phone:216-529-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP01060363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7563433OtherAETNA
OH000000226064OtherUNISON
OH743709OtherBUCKEYE
OHP00445902OtherRAILROAD MEDICARE
OH000000541027OtherANTHEM
OH422452OtherWELLCARE
OH2160610Medicaid
OH000000226064OtherUNISON
OH743709OtherBUCKEYE
OHP00445902OtherRAILROAD MEDICARE