Individual
MR. WAYNE ALEXANDER JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A-C
Contact information
Practice address
243 WINKLER TRL, COLOGNE, MN 55322-8013
(612) 720-3985
Mailing address
1305 15TH ST NE APT 314, SAUK RAPIDS, MN 56379-2379
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10335
MN
363A00000X
Physician Assistant
1044
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
812998000
—
MN
Enumeration date
08/13/2007
Last updated
04/08/2020
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