Individual
HEATHER RENEE IRELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, FNP-C
Contact information
Practice address
805 BLOOMINGTON RD, CHAMPAIGN, IL 61820-2101
(217) 600-7165
Mailing address
2501 CHATHAM RD # 4686, SPRINGFIELD, IL 62704-4188
(217) 681-3290
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
277003170
IL
363LF0000X
Family Nurse Practitioner
71007116A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
277003170
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277.003170
APRN-FPA
IL
Enumeration date
12/28/2016
Last updated
08/15/2024
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