Provider Demographics
NPI:1801938469
Name:MOHLKE, SUE E (BSN, RN, CSA)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:E
Last Name:MOHLKE
Suffix:
Gender:F
Credentials:BSN, RN, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 STATE ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3134
Mailing Address - Country:US
Mailing Address - Phone:219-325-0152
Mailing Address - Fax:219-325-8621
Practice Address - Street 1:1300 STATE ST STE 2C
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3134
Practice Address - Country:US
Practice Address - Phone:219-325-0152
Practice Address - Fax:219-325-8621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28081333A163WM0705X
IN2989246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical