Doctor Name: | MS. COURTNEY M JAEGLE |
NPI Number: | 1013196682 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | |
Business Practice Address: | 2100 Glenwood Ave Joliet, IL - 604355487 |
Business Phone Number: | 8157252121 |
Business Fax Number: | 8157416303 |
Mailing Address: | 2100 Glenwood Ave, JOLIET |
State: | IL |
Postal Code: | 604355487 |
Phone Number: | 8157252121 |
Fax Number: | 8157416303 |
NPI Enumeration Date: | 10/30/2007 |
NPI Last Update Date: | 10/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |