Provider Demographics
NPI:1154077618
Name:RAU, KRISTEN (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RAU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 GEORGE WASHINGTON MEMORIAL HWY UNIT 554
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER POINT
Mailing Address - State:VA
Mailing Address - Zip Code:23062-2747
Mailing Address - Country:US
Mailing Address - Phone:480-282-7187
Mailing Address - Fax:
Practice Address - Street 1:350 W MCLELLAN RD UNIT 4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-2262
Practice Address - Country:US
Practice Address - Phone:480-282-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ265811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily