Individual
SANDRA JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
16313 LAKE AVE, LAKEWOOD, OH 44107-1250
(216) 529-9727
Mailing address
16313 LAKE AVE, LAKEWOOD, OH 44107-1250
(216) 529-9727
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
NP01060
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000226064
UNISON
OH
01
—
000000541027
ANTHEM
OH
05
—
2160610
—
OH
01
—
422452
WELLCARE
OH
01
—
743709
BUCKEYE
OH
01
—
7563433
AETNA
OH
01
—
P00445902
RAILROAD MEDICARE
OH
Enumeration date
07/15/2006
Last updated
07/03/2012
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