Provider Demographics
NPI:1568474575
Name:RAHE, SOHYON MIN (ARNP MS)
Entity Type:Individual
Prefix:MRS
First Name:SOHYON
Middle Name:MIN
Last Name:RAHE
Suffix:
Gender:F
Credentials:ARNP MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 CENTER ST. NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-585-5351
Mailing Address - Fax:503-585-4908
Practice Address - Street 1:3180 CENTER ST. NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-585-5351
Practice Address - Fax:503-585-4908
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081000541N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9638487Medicaid
WAGAB40268Medicare ID - Type Unspecified
S54938Medicare UPIN