Provider Demographics
NPI:1285179986
Name:BOSTON, KERI A (RN BSN IBCLC)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:A
Last Name:BOSTON
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1596
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-1596
Mailing Address - Country:US
Mailing Address - Phone:309-202-5393
Mailing Address - Fax:309-925-3028
Practice Address - Street 1:1800 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3822
Practice Address - Country:US
Practice Address - Phone:309-929-0296
Practice Address - Fax:309-925-3028
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.385521163W00000X
ILL-127068163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse