Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 062656 | CT |
NPI | 1023368370 |
---|---|
Provider Name | Dr. Jennifer Rose Jorgensen |
First Address | Farmington, CT 06030-8082 |
Second Address | Farmington, CT 06030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 18/06/2019 |