Individual
DR. RILEY RENEE CLUBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN, DNP, PMHNP
Contact information
Practice address
6805 IL-162, MARYVILLE, IL 62062
(618) 288-5019
Mailing address
6805 IL-162, MARYVILLE, IL 62062
(618) 288-5019
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.454256
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209029835
IL
Other
Enumeration date
05/30/2023
Last updated
06/21/2024
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