Provider Demographics
NPI:1538497821
Name:HAAG, JESSICA (CNM, MSN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAAG
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MURTAGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, MSN
Mailing Address - Street 1:3303 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4036
Mailing Address - Country:US
Mailing Address - Phone:773-277-6589
Mailing Address - Fax:773-277-9548
Practice Address - Street 1:3303 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4036
Practice Address - Country:US
Practice Address - Phone:773-277-6589
Practice Address - Fax:773-277-9548
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007765367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN