Provider Demographics
NPI:1487321436
Name:JESSEN, SARAH GRACE (APRN)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:GRACE
Last Name:JESSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 E NORTH PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-7403
Mailing Address - Country:US
Mailing Address - Phone:815-260-7441
Mailing Address - Fax:
Practice Address - Street 1:903 N 129TH INFANTRY DR STE 400
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5002
Practice Address - Country:US
Practice Address - Phone:815-725-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023798363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine