Provider Demographics
NPI:1376885616
Name:RAU, SASHA PAIGE
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:PAIGE
Last Name:RAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 W LAKEWAY RD
Mailing Address - Street 2:STE 3
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 W LAKEWAY RD
Practice Address - Street 2:STE 3
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6372
Practice Address - Country:US
Practice Address - Phone:605-393-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR034715163W00000X
WY343221349367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse