Provider Demographics
NPI:1841594058
Name:JERSAN, JENNIFER LYNN (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:JERSAN
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 1:718 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1348
Mailing Address - Country:US
Mailing Address - Phone:812-222-3627
Mailing Address - Fax:812-663-1155
Practice Address - Street 1:718 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1348
Practice Address - Country:US
Practice Address - Phone:812-222-3627
Practice Address - Fax:812-663-1155
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003497A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71003497AOtherLICENSE NUMBER