Provider Demographics
NPI:1437120763
Name:JORGENSON, JOANN M (WHCNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 190TH ST S
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56549-9056
Mailing Address - Country:US
Mailing Address - Phone:218-483-4786
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN AVE
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2752
Practice Address - Country:US
Practice Address - Phone:701-232-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1025961363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
38887OtherSIOUX VALLEY HEALTH PLAN
120234OtherUCARE
07-02622OtherMEDICA
MN68G23JOOtherBCBS MN
1013314OtherPREFERRED ONE
HP21441OtherHEALTH PARTNERS
973457OtherAMERICA'S PPO (ARAZ)
38887OtherSIOUX VALLEY HEALTH PLAN