Basic Information
| Provider Information | |||||||||
| NPI: | 1568474575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAHE | ||||||||
| FirstName: | SOHYON | ||||||||
| MiddleName: | MIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3180 CENTER ST. NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035855351 | ||||||||
| FaxNumber: | 5035854908 | ||||||||
| Practice Location | |||||||||
| Address1: | 3180 CENTER ST. NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035855351 | ||||||||
| FaxNumber: | 5035854908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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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 | 363LP0808X | 081000541N6 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 9638487 | 05 | WA | MEDICAID |