Provider Demographics
NPI:1528382207
Name:BETTENHAUSEN, SUSAN K (APRN, CDE, RD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:BETTENHAUSEN
Suffix:
Gender:F
Credentials:APRN, CDE, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-8605
Mailing Address - Country:US
Mailing Address - Phone:630-469-2000
Mailing Address - Fax:
Practice Address - Street 1:1020 E OGDEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8610
Practice Address - Country:US
Practice Address - Phone:630-789-4910
Practice Address - Fax:630-789-4911
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004249363L00000X, 364S00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist