Basic Information
| Provider Information | |||||||||
| NPI: | 1073912200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAUSCH | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 6TH ST SE | ||||||||
| Address2: | |||||||||
| City: | PRIMGHAR | ||||||||
| State: | IA | ||||||||
| PostalCode: | 512451104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122300030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 N RERICK AVE | ||||||||
| Address2: | |||||||||
| City: | PRIMGHAR | ||||||||
| State: | IA | ||||||||
| PostalCode: | 512457786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7129572310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2014 | ||||||||
| LastUpdateDate: | 08/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A117814 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.