Provider Demographics
NPI:1639100514
Name:ZEBOLD, KERRY FITZGERALD (RN, MSN, PNP)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:FITZGERALD
Last Name:ZEBOLD
Suffix:
Gender:F
Credentials:RN, MSN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-4192
Mailing Address - Fax:773-880-3503
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:#30
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4192
Practice Address - Fax:773-880-3053
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209-003528363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics