Provider Demographics
NPI:1144672627
Name:REICHLING, SHELLEY DAWN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:DAWN
Last Name:REICHLING
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-1209
Mailing Address - Country:US
Mailing Address - Phone:618-282-6656
Mailing Address - Fax:618-282-4277
Practice Address - Street 1:824 LOCUST ST
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-1209
Practice Address - Country:US
Practice Address - Phone:618-282-6656
Practice Address - Fax:618-282-4277
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014289363LF0000X
IL209014289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily