Provider Demographics
NPI:1720319320
Name:JORGENSON, MARCILLE (RN)
Entity type:Individual
Prefix:
First Name:MARCILLE
Middle Name:
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 CADENCE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6479
Mailing Address - Country:US
Mailing Address - Phone:702-407-9866
Mailing Address - Fax:
Practice Address - Street 1:1361 CADENCE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6479
Practice Address - Country:US
Practice Address - Phone:702-407-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN43932163WA2000X
WI74058-30163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator