Provider Demographics
NPI:1194367912
Name:KRIEBS, MATT J (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:J
Last Name:KRIEBS
Suffix:
Gender:M
Credentials:APRN, 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:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-0516
Mailing Address - Country:US
Mailing Address - Phone:904-490-0264
Mailing Address - Fax:
Practice Address - Street 1:18W140 BUTTERFIELD RD FL 15
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4843
Practice Address - Country:US
Practice Address - Phone:904-490-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily