Active NPI
Stefanie Riley, RD
- Registered Dietitian
- Galesburg, IL
National Provider Identifier
1588088777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164005775
- Practice address
- 1975 National Blvd
Galesburg, IL 61401-1488 - Phone
- (309) 344-1100
- Fax
- (309) 344-1204
- NPI assigned
- Feb 10, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164005775 | IL | Primary |
Addresses
Primary practice location
1975 National Blvd
Galesburg, IL 61401-1488
Mailing address
2717 Clearview Drive
Burlington, IA 52601
Phone (815) 519-2891
Other names 1
- Stefanie Djuric
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164005775 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1588088777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2717 CLEARVIEW DRIVE",
"city": "BURLINGTON",
"state": "IA",
"postal_code": "52601",
"telephone_number": "815-519-2891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1975 NATIONAL BLVD",
"city": "GALESBURG",
"state": "IL",
"postal_code": "614011488",
"telephone_number": "309-344-1100",
"fax_number": "309-344-1204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILEY",
"first_name": "STEFANIE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-10",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164005775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STEFANIE",
"last_name": "DJURIC",
"credential": "RD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Galesburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.