Provider Demographics
NPI:1093015703
Name:KELLER, CHERYL ANNE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANNE
Last Name:KELLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:ANNE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 ELM CREEK DR
Mailing Address - Street 2:APT 409
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5609
Mailing Address - Country:US
Mailing Address - Phone:309-212-0382
Mailing Address - Fax:
Practice Address - Street 1:155 E BRUSH HILL RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5658
Practice Address - Country:US
Practice Address - Phone:331-221-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008514041.347026367500000X
IL041347026163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse