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General NPI Number Information
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NPI Number | 1881139905
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Entity Type | Individual
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Provider Name | HEATHER RENEE IRELAN PMHNP-BC, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 805 BLOOMINGTON RD
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City | CHAMPAIGN
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State | IL
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Zip | 61820-2101
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Country | US
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Telephone | 217-600-7165
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD # 4686
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 217-681-3290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277003170
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71007116A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277003170
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License Number State | IL
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