Provider Demographics
NPI:1073912200
Name:RAUSCH, AMANDA J (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PRIMGHAR
Mailing Address - State:IA
Mailing Address - Zip Code:51245-1104
Mailing Address - Country:US
Mailing Address - Phone:712-230-0030
Mailing Address - Fax:
Practice Address - Street 1:240 N RERICK AVE
Practice Address - Street 2:
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245-7786
Practice Address - Country:US
Practice Address - Phone:712-957-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA117814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily