Basic Information
| Provider Information | |||||||||
| NPI: | 1386640605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAAHAUGE | ||||||||
| FirstName: | BRIGITTE | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 172 SCHILLER | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601262885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312216377 | ||||||||
| FaxNumber: | 3312212701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 S. YORK RD. | ||||||||
| Address2: | SUITE 4120 | ||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312219009 | ||||||||
| FaxNumber: | 3312213977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 03/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 3660269 | 05 | TN | MEDICAID | 100048475 | 01 | TN | PHP TNCARE | OTHER | 4098312 | 01 | TN | BCBS/BC/TCS | OTHER | TN0103 | 01 | TN | JOHNDEERE TNCARE | OTHER |