Provider Demographics
NPI:1043855745
Name:RAUCH, CARLY L (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:L
Last Name:RAUCH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3734
Mailing Address - Country:US
Mailing Address - Phone:740-346-2702
Mailing Address - Fax:740-346-2645
Practice Address - Street 1:148 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3734
Practice Address - Country:US
Practice Address - Phone:740-346-2702
Practice Address - Fax:740-346-2645
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0379457Medicaid