Provider Demographics
NPI:1619943040
Name:JORGENSEN, JANE (NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 7TH ST SW
Mailing Address - Street 2:APT 814
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2442
Mailing Address - Country:US
Mailing Address - Phone:202-863-1140
Mailing Address - Fax:
Practice Address - Street 1:200 FONT HILL AVE
Practice Address - Street 2:HEALTH SUITE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2703
Practice Address - Country:US
Practice Address - Phone:410-396-0046
Practice Address - Fax:410-545-6272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR136408363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics