Provider Demographics
NPI:1922118967
Name:RABENBER, SUSAN M (NP, CNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:RABENBER
Suffix:
Gender:F
Credentials:NP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-1803
Mailing Address - Country:US
Mailing Address - Phone:952-758-1050
Mailing Address - Fax:952-758-5011
Practice Address - Street 1:202 1ST ST S
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:MN
Practice Address - Zip Code:56069-1602
Practice Address - Country:US
Practice Address - Phone:507-364-5600
Practice Address - Fax:507-364-5686
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR130725-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN257504300Medicaid
MNP60986Medicare UPIN
MN257504300Medicaid