Provider Demographics
NPI:1053779751
Name:JAHNS, CORINNE ROSE (NP)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:ROSE
Last Name:JAHNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:CORINNE
Other - Middle Name:ROSE
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2239 E COOK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-1944
Mailing Address - Country:US
Mailing Address - Phone:217-788-2300
Mailing Address - Fax:217-788-2341
Practice Address - Street 1:2239 E COOK ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-1944
Practice Address - Country:US
Practice Address - Phone:217-788-2300
Practice Address - Fax:217-788-2341
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily