Basic Information
Provider Information
NPI: 1558604298
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JURGENSMIER
FirstName: LORI
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 420 E DIVISION ST
Address2:  
City: FOND DU LAC
State: WI
PostalCode: 549354560
CountryCode: US
TelephoneNumber: 9209268340
FaxNumber:  
Practice Location
Address1: 430 E DIVISION ST
Address2:  
City: FOND DU LAC
State: WI
PostalCode: 549354560
CountryCode: US
TelephoneNumber: 9209292300
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/01/2013
LastUpdateDate: 04/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WM0705X119755WIY Nursing Service ProvidersRegistered NurseMedical-Surgical

No ID Information.


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