Glen Jorgensen, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R029292 Issued in SD

Practice address

24276 166 Street Airport Rd
Eagle Butte, SD 57625-1012

Phone

(605) 964-7724

Fax

(605) 964-1342

NPI assigned

Sep 10, 2015

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 10, 2015.

{
    "created_epoch": "1441843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1851769640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24276 166 ST",
            "city": "EAGLE BUTTE",
            "state": "SD",
            "postal_code": "576251012",
            "telephone_number": "605-964-7724",
            "fax_number": "605-964-1342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24276 166 STREET AIRPORT RD",
            "city": "EAGLE BUTTE",
            "state": "SD",
            "postal_code": "576251012",
            "telephone_number": "605-964-7724",
            "fax_number": "605-964-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSEN",
        "first_name": "GLEN",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-10",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SD",
            "license": "R029292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Deleen Jean Kougl, CNP
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• All providers in Eagle Butte, SD
• Registered Nurse in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.