Provider Demographics
NPI:1922042100
Name:BALDWIN, KERRI KELLER (APN)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:KELLER
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 E CHESTNUT
Mailing Address - Street 2:55J
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:773-975-8813
Mailing Address - Fax:773-880-4588
Practice Address - Street 1:2300 CHILDREN'S PLAZA
Practice Address - Street 2:BOX 63
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3394
Practice Address - Country:US
Practice Address - Phone:773-975-8813
Practice Address - Fax:773-880-4588
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004821363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics