Provider Demographics
NPI:1891736518
Name:AARDEMA-COUGHLIN, SUSAN JOY (APRN, CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOY
Last Name:AARDEMA-COUGHLIN
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10921 W SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-8572
Mailing Address - Country:US
Mailing Address - Phone:815-685-1265
Mailing Address - Fax:
Practice Address - Street 1:350 N WALL ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2901
Practice Address - Country:US
Practice Address - Phone:815-937-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041263936367500000X
IL209000752367500000X
FL11029190367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered