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General NPI Number Information
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NPI Number | 1487321436
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Entity Type | Individual
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Provider Name | SARAH GRACE JESSEN APRN
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 903 N 129TH INFANTRY DR STE 400
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City | JOLIET
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State | IL
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Zip | 60435-5002
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Country | US
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Telephone | 815-725-2653
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Fax |
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Provider Business Mailing Address
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Address Line | 6445 E NORTH PRAIRIE DR
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City | MORRIS
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State | IL
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Zip | 60450-7403
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Country | US
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Telephone | 815-260-7441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 209.023798
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License Number State | IL
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