Provider Demographics
NPI:1306089024
Name:PRANGE, JESSICA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JEAN
Last Name:PRANGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:JEAN
Other - Last Name:JATCKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2006
Mailing Address - Country:US
Mailing Address - Phone:217-342-2121
Mailing Address - Fax:217-347-1563
Practice Address - Street 1:503 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2006
Practice Address - Country:US
Practice Address - Phone:217-342-2121
Practice Address - Fax:217-347-1563
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036.137347207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036137347Medicaid
ILP01514409OtherRAILROAD
ILP01514409OtherRAILROAD