Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 290071-4405 | UT |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 290071-8900 | UT |
NPI | 1174792352 |
---|---|
Provider Name | Jennifer Lee Jorgenson |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Provo, UT 84604-3380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2008 |
Last Update Date | 04/01/2022 |