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Individual

TAMMY LEE CLARKJORGENSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
912 CLEVELAND ST, WATERTOWN, WI 53098-2925
(920) 723-4124
Mailing address
912 CLEVELAND ST, WATERTOWN, WI 53098-2925
(920) 723-4124

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
34047-031
WI

Other

Enumeration date
12/15/2009
Last updated
12/15/2009
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