Provider Demographics
NPI:1699930396
Name:RAHN, MARY LOUISE (APN)
Entity type:Individual
Prefix:MRS
First Name:MARY LOUISE
Middle Name:
Last Name:RAHN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MARY LOUISE
Other - Middle Name:
Other - Last Name:MUNAFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:8 HIDEAWAY LANE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWSP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234
Mailing Address - Country:US
Mailing Address - Phone:609-601-6029
Mailing Address - Fax:609-653-6648
Practice Address - Street 1:2030 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1042
Practice Address - Country:US
Practice Address - Phone:609-653-0009
Practice Address - Fax:609-653-6648
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN11241600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ046107ZCFYMedicare PIN