Individual
MS. COURTNEY M JAEGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
112 NE CRESCENT AVE, PEORIA, IL 61606-1901
(309) 672-4670
(309) 672-4669
Mailing address
112 NE CRESCENT AVE, PEORIA, IL 61606-1901
(309) 672-4670
(815) 741-6303
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0085003098
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003098
LICENSE
IL
05
—
085003098
—
IL
Enumeration date
10/30/2007
Last updated
09/28/2020
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