Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209.023798 | IL |
NPI | 1487321436 |
---|---|
Provider Name | Mrs. Sarah Grace Jessen |
First Address | Morris, IL 60450-7403 |
Second Address | Joliet, IL 60435-5002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2021 |
Last Update Date | 26/08/2021 |