Provider Demographics
NPI:1952088346
Name:JORGENSEN, JERRILYNN H (LPN)
Entity Type:Individual
Prefix:
First Name:JERRILYNN
Middle Name:H
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 S CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5041
Mailing Address - Country:US
Mailing Address - Phone:801-380-8141
Mailing Address - Fax:
Practice Address - Street 1:40 N 200 W
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1714
Practice Address - Country:US
Practice Address - Phone:801-258-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT163801-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse