Basic Information
| Provider Information | |||||||||
| NPI: | 1720599673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERRSCHNEIDER | ||||||||
| FirstName: | KARLI | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 WEST ST BLDG B | ||||||||
| Address2: | |||||||||
| City: | PERU | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613542763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5636506898 | ||||||||
| FaxNumber: | 8152203618 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BERGSLIEN ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156841111 | ||||||||
| FaxNumber: | 7156841119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2017 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 209.016754 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 367A00000X | 209.016754 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 209.016754 | 01 | IL | ILLINOIS CNM LICENSE | OTHER | 148950-32 | 01 | WI | NURSE MIDWIFE | OTHER | 8366-33 | 01 | WI | A.P.N.P. | OTHER |