Provider Demographics
NPI:1417206285
Name:RAU, ANDREA (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MONROE ST STE 231I
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3462
Mailing Address - Country:US
Mailing Address - Phone:567-245-1976
Mailing Address - Fax:877-920-2076
Practice Address - Street 1:5151 MONROE ST STE 231I
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3462
Practice Address - Country:US
Practice Address - Phone:567-245-1976
Practice Address - Fax:877-920-2076
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA13805NP363LF0000X
MI4704270697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily