Provider Demographics
NPI:1730684390
Name:FISCHER-JORGENSEN, TAMMY JO (LPN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:FISCHER-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 1:123 N MARIAN RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4673
Mailing Address - Country:US
Mailing Address - Phone:402-462-4187
Mailing Address - Fax:402-462-4568
Practice Address - Street 1:123 N MARIAN RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4673
Practice Address - Country:US
Practice Address - Phone:402-462-4187
Practice Address - Fax:402-462-4568
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18074164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse