Provider Demographics
NPI:1467846600
Name:RAUSCH, CAMMIE
Entity Type:Individual
Prefix:
First Name:CAMMIE
Middle Name:
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAMMIE
Other - Middle Name:KAY
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:1465 S EATON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5801
Mailing Address - Country:US
Mailing Address - Phone:206-778-8773
Mailing Address - Fax:
Practice Address - Street 1:3885 UPHAM ST STE 100
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4800
Practice Address - Country:US
Practice Address - Phone:303-742-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0991694-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology