Provider Demographics
NPI:1720599673
Name:KERRSCHNEIDER, KARLI RAE (CNM)
Entity Type:Individual
Prefix:
First Name:KARLI
Middle Name:RAE
Last Name:KERRSCHNEIDER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WEST ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2763
Mailing Address - Country:US
Mailing Address - Phone:563-650-6898
Mailing Address - Fax:815-220-3618
Practice Address - Street 1:1100 BERGSLIEN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002
Practice Address - Country:US
Practice Address - Phone:715-684-1111
Practice Address - Fax:715-684-1119
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016754363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.016754OtherILLINOIS CNM LICENSE
WI148950-32OtherNURSE MIDWIFE
WI8366-33OtherA.P.N.P.