Healthcare Provider Details

I. General information

NPI: 1336603174
Provider Name (Legal Business Name): JESSICA MURGLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 BRANDING AVENUE SUITE 310
DOWNERS GROVE IL
60515
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 262-693-4402
  • Fax: 708-283-5599
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209019134
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: