Provider Demographics
NPI:1295290575
Name:JESPERSEN, PATRICK (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:JESPERSEN
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 NIOBRARA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMINGFORD
Mailing Address - State:NE
Mailing Address - Zip Code:69348-3102
Mailing Address - Country:US
Mailing Address - Phone:308-487-7425
Mailing Address - Fax:
Practice Address - Street 1:911 NIOBRARA AVE
Practice Address - Street 2:
Practice Address - City:HEMINGFORD
Practice Address - State:NE
Practice Address - Zip Code:69348-3102
Practice Address - Country:US
Practice Address - Phone:308-487-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79339163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool