Provider Demographics
NPI:1528756046
Name:JURGENSEN, IRENE G (RN)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:G
Last Name:JURGENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 CREEK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1180
Mailing Address - Country:US
Mailing Address - Phone:585-406-1574
Mailing Address - Fax:
Practice Address - Street 1:1633 CREEK ST APT 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1180
Practice Address - Country:US
Practice Address - Phone:585-406-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse