Individual
MRS. DEANNE C RIECKENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
215 S BURNS AVE, SPARTA MEDICAL OFFICE, SPARTA, IL 62286
(618) 443-4889
Mailing address
215 S BURNS AVE, SPARTA MEDICAL OFFICE, SPARTA, IL 62286
(618) 443-4889
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209005645
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041-315519
ILLINOIS LICENSE
IL
01
—
2005004617
ANCC CERTIFICATION NUMBER
—
Enumeration date
02/21/2006
Last updated
06/04/2020
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