Provider Demographics
NPI:1346542248
Name:RADER, BARBARA J (115208-30)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:RADER
Suffix:
Gender:F
Credentials:115208-30
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 HARDER CT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1113
Mailing Address - Country:US
Mailing Address - Phone:815-633-5988
Mailing Address - Fax:
Practice Address - Street 1:1467 HARDER CT
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1113
Practice Address - Country:US
Practice Address - Phone:815-633-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-28
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI115208-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38229500Medicaid