Individual
MR. GLEN JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
24276 166 STREET AIRPORT RD, EAGLE BUTTE, SD 57625-1012
(605) 964-7724
(605) 964-1342
Mailing address
24276 166 ST, EAGLE BUTTE, SD 57625-1012
(605) 964-7724
(605) 964-1342
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R029292
SD
Other
Enumeration date
09/10/2015
Last updated
09/10/2015
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