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NPI Code Detail

MEDICARE: MS. CONSTANCE JAEGLE R.N., M.S., NP

MEDICARE: MS. CONSTANCE JAEGLE R.N., M.S., NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner041154564IL

General Provider Information

NPI Number : 1629021332
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CONSTANCE JAEGLE R.N., M.S., NP
Provider Business Mailing Address
First Line : 1766 N 21ST RD
Second Line :
City : GRAND RIDGE
State : IL
Zip : 61325-9662
Country : US
Telephone Number : 815-257-0007
Fax Number :
Provider Business Practice Location Address
First Line : 1900 SILVER CROSS BLVD
Second Line :
City : NEW LENOX
State : IL
Zip : 60451-9509
Country : US
Telephone Number : 815-469-1367
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/09/2020

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