Provider Demographics
NPI:1538313614
Name:RUMELHART, SUSAN E (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:RUMELHART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 20TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1635
Mailing Address - Country:US
Mailing Address - Phone:319-558-3473
Mailing Address - Fax:
Practice Address - Street 1:1243 20TH ST SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1635
Practice Address - Country:US
Practice Address - Phone:319-558-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC-061714363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0239434Medicaid