Healthcare Provider Details

I. General information

NPI: 1639124704
Provider Name (Legal Business Name): DIANE KERNAN-SCHROEDER APRN, BC-ADM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AVE AND ROOSEVELT RD MAIL ROUTE 11C9
HINES IL
60141
US

IV. Provider business mailing address

5001 W WAVELAND AVE
CHICAGO IL
60641-3420
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-7258
  • Fax:
Mailing address:
  • Phone: 773-685-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: