Provider Demographics
NPI:1700906021
Name:SCHIERBAUM, KATHY L (APN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:SCHIERBAUM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 DUTCHMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TUNNEL HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62972-3127
Mailing Address - Country:US
Mailing Address - Phone:618-833-2295
Mailing Address - Fax:618-833-9058
Practice Address - Street 1:517 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1668
Practice Address - Country:US
Practice Address - Phone:618-833-2295
Practice Address - Fax:618-833-9058
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001177363LF0000X
IL209001177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-001177OtherSTATE LICENSE NUMBER