Healthcare Provider Details

I. General information

NPI: 1346192127
Provider Name (Legal Business Name): LAURA L KRIEGHAUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA L HAYWARD

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 NE GLEN OAK AVE
PEORIA IL
61636-1000
US

IV. Provider business mailing address

301 S STILLWATER DR
CHILLICOTHEE IL
61523-1219
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-5522
  • Fax:
Mailing address:
  • Phone: 815-712-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035925
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041348328
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: