Healthcare Provider Details

I. General information

NPI: 1497415152
Provider Name (Legal Business Name): HEIDI RENEE RILEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 N SEMINARY ST
GALESBURG IL
61401-1251
US

IV. Provider business mailing address

1929 CLARK ST
GALESBURG IL
61401-1459
US

V. Phone/Fax

Practice location:
  • Phone: 309-344-1000
  • Fax:
Mailing address:
  • Phone: 309-371-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024285
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: