Healthcare Provider Details

I. General information

NPI: 1891736518
Provider Name (Legal Business Name): SUSAN JOY AARDEMA-COUGHLIN APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN COUGHLIN

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N WALL ST
KANKAKEE IL
60901-2901
US

IV. Provider business mailing address

10921 W SADDLE DR
MONEE IL
60449-8572
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-2375
  • Fax:
Mailing address:
  • Phone: 815-685-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041263936
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11029190
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA253054
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209000752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: