Individual
JENNIFER A HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
200 E FAIRMAN AVE, WATSEKA, IL 60970-1644
(815) 432-5041
(815) 432-7821
Mailing address
2141 E BLACKBERRY CT, WATSEKA, IL 60970-7512
(815) 432-7778
(815) 432-7821
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209-003217
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041-264487
LICENSE NUMBER
IL
Enumeration date
04/16/2007
Last updated
06/16/2022
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