Provider Demographics
NPI:1891560538
Name:MAAG, JENNA M (NP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:MAAG
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:650 MARYVILLE UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7299
Mailing Address - Country:US
Mailing Address - Phone:314-529-9360
Mailing Address - Fax:314-529-9925
Practice Address - Street 1:503 W PINE ST
Practice Address - Street 2:
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567-3300
Practice Address - Country:US
Practice Address - Phone:605-859-3875
Practice Address - Fax:605-859-3506
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-12-11
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Provider Licenses
StateLicense IDTaxonomies
SDCP003038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty