Provider Demographics
NPI:1366212748
Name:RAHENKAMP, KATHERINE (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:RAHENKAMP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 OPUS PL STE 110
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1164
Mailing Address - Country:US
Mailing Address - Phone:888-279-0002
Mailing Address - Fax:
Practice Address - Street 1:301 MCCULLOUGH DR FL 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3310
Practice Address - Country:US
Practice Address - Phone:888-279-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019522364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health