Healthcare Provider Details

I. General information

NPI: 1053779751
Provider Name (Legal Business Name): CORINNE ROSE JAHNS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CORINNE ROSE KRUGER

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 E COOK ST
SPRINGFIELD IL
62703-1944
US

IV. Provider business mailing address

2239 E COOK ST
SPRINGFIELD IL
62703-1944
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-2300
  • Fax: 217-788-2341
Mailing address:
  • Phone: 217-788-2300
  • Fax: 217-788-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013838
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: