Provider Demographics
NPI:1629070933
Name:RAHN, SUSAN K (RN MS FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:RAHN
Suffix:
Gender:F
Credentials:RN MS FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:421 W EXCHANGE ST PO BOX 268
Mailing Address - Street 2:BUSINESS OPTIONS MEDICAL BILLING
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-0268
Mailing Address - Country:US
Mailing Address - Phone:815-599-7950
Mailing Address - Fax:815-599-7974
Practice Address - Street 1:1010 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6600
Practice Address - Country:US
Practice Address - Phone:815-599-7740
Practice Address - Fax:815-599-7650
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO119161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81327714Medicaid
RAR 66933OtherBLUE CROSS
CO840874926002OtherROCKY MOUNTAIN HEALTHPLAN
P01361490OtherRAILROAD WORKERS MEDICARE FOR OLATHE COMM CLINIC DBA RIVER VALLEY FAMILY HEALTH
COC802962Medicare PIN
COQ10950Medicare UPIN