Healthcare Provider Details

I. General information

NPI: 1295577856
Provider Name (Legal Business Name): HALEY ERIN JUNGE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N 64TH ST
BELLEVILLE IL
62223-3809
US

IV. Provider business mailing address

1003 MARTIN LUTHER KING DR
BLOOMINGTON IL
61701-1429
US

V. Phone/Fax

Practice location:
  • Phone: 618-877-4420
  • Fax: 618-512-1920
Mailing address:
  • Phone: 888-924-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041517819
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.032719
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: