Healthcare Provider Details

I. General information

NPI: 1740821297
Provider Name (Legal Business Name): JESSICA MAAG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

103 LITTLE MOUNTAIN RD
NINETY SIX SC
29666-9252
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0029925
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number23283
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: