Provider Demographics
NPI:1578970505
Name:JUENGER, JOELLEN (APN)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:JUENGER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:JUENGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, FNP-BC
Mailing Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-6805
Mailing Address - Country:US
Mailing Address - Phone:618-512-1919
Mailing Address - Fax:
Practice Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-6805
Practice Address - Country:US
Practice Address - Phone:618-512-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily