Provider Demographics
NPI:1225035843
Name:RAU, PATRICIA K (MSN, CGRN, ANP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:RAU
Suffix:
Gender:F
Credentials:MSN, CGRN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 LAFAYETTE AVE SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4693
Mailing Address - Country:US
Mailing Address - Phone:616-752-6525
Mailing Address - Fax:616-752-6556
Practice Address - Street 1:310 LAFAYETTE AVE SE
Practice Address - Street 2:SUITE 400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4693
Practice Address - Country:US
Practice Address - Phone:616-752-6525
Practice Address - Fax:616-752-6556
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704141476163WG0100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4385281Medicaid
MI0D16197Medicare ID - Type Unspecified
MI4385281Medicaid