Healthcare Provider Details

I. General information

NPI: 1760743470
Provider Name (Legal Business Name): REGINA M STILLING CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COMMERCE DR
CRYSTAL LAKE IL
60014-3539
US

IV. Provider business mailing address

333 COMMERCE DR
CRYSTAL LAKE IL
60014-3539
US

V. Phone/Fax

Practice location:
  • Phone: 779-356-4095
  • Fax:
Mailing address:
  • Phone: 779-356-4095
  • Fax: 779-356-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009570
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009570
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277.005255
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: