Basic Information
| Provider Information | |||||||||
| NPI: | 1598337594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JURGENS | ||||||||
| FirstName: | MICHAEL ANN | ||||||||
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| Credential: | SRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410712246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593918501 | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 GOODMAN ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135841000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2021 | ||||||||
| LastUpdateDate: | 07/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN.408339 | OH | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 390200000X | RN.408339 | OH | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.