Healthcare Provider Details

I. General information

NPI: 1528382207
Provider Name (Legal Business Name): SUSAN K BETTENHAUSEN APRN, CDE, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 E OGDEN AVE STE 100
NAPERVILLE IL
60563-8610
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-8605
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-4910
  • Fax: 630-789-4911
Mailing address:
  • Phone: 630-469-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209004249
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209004249
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number209004249
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: