Healthcare Provider Details

I. General information

NPI: 1003881244
Provider Name (Legal Business Name): DEANNE C RIECKENBERG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNE C PFIEFFER CFNP

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S BURNS AVE SPARTA MEDICAL OFFICE
SPARTA IL
62286
US

IV. Provider business mailing address

215 S BURNS AVE SPARTA MEDICAL OFFICE
SPARTA IL
62286
US

V. Phone/Fax

Practice location:
  • Phone: 618-443-4889
  • Fax:
Mailing address:
  • Phone: 618-443-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209005645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: