Provider Demographics
NPI:1629646567
Name:HAGER, MARLEE N
Entity Type:Individual
Prefix:
First Name:MARLEE
Middle Name:N
Last Name:HAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLEE
Other - Middle Name:N
Other - Last Name:LANDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 FOUNDERS LN STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3924
Mailing Address - Country:US
Mailing Address - Phone:217-243-0300
Mailing Address - Fax:
Practice Address - Street 1:15 FOUNDERS LN STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3924
Practice Address - Country:US
Practice Address - Phone:217-243-0300
Practice Address - Fax:217-862-0202
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.444252OtherRN