Individual
JACLYN JOY HAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
715 BROADWAY ST, GILLESPIE, IL 62033-1166
(217) 839-2689
(217) 839-2689
Mailing address
715 BROADWAY ST, GILLESPIE, IL 62033-1166
(217) 839-2689
(217) 839-2689
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085003429
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003429
IL LICENSE
IL
Enumeration date
02/10/2009
Last updated
04/11/2014
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