Provider Demographics
NPI:1649867821
Name:HEADLEY, RICHELLE THERESA (APN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:RICHELLE
Middle Name:THERESA
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:RICHELLE
Other - Middle Name:THERESA
Other - Last Name:PRIMBAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:40 75TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2325
Mailing Address - Country:US
Mailing Address - Phone:630-581-5372
Mailing Address - Fax:
Practice Address - Street 1:40 75TH ST
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2325
Practice Address - Country:US
Practice Address - Phone:630-581-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209022551OtherSTATE OF ILLINOIS APN LICENSE NUMBER