Basic Information
| Provider Information | |||||||||
| NPI: | 1396824918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAHE | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2346 MORMON TREK BLVD | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522464371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193377642 | ||||||||
| FaxNumber: | 3193391449 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 LIONS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH LIBERTY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523179575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3194675050 | ||||||||
| FaxNumber: | 3194677130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 08/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A108489 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | P00634369 | 01 | IA | RR MEDICARE | OTHER | 0733535 | 05 | IA | MEDICAID | 1396824918 | 05 | IA | MEDICAID |