Provider Demographics
NPI:1639124704
Name:KERNAN-SCHROEDER, DIANE (APRN, BC-ADM)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:KERNAN-SCHROEDER
Suffix:
Gender:F
Credentials:APRN, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 W WAVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3420
Mailing Address - Country:US
Mailing Address - Phone:773-685-7021
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE AND ROOSEVELT RD
Practice Address - Street 2:MAIL ROUTE 11C9
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist