Provider Demographics
NPI:1558708776
Name:RAUER, COURTNEY AE (APRN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:AE
Last Name:RAUER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:A
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-479-3302
Mailing Address - Fax:802-225-5733
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:CVMC ADULT PRIMARY CARE-BARRE
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4881
Practice Address - Country:US
Practice Address - Phone:802-479-3302
Practice Address - Fax:802-225-5733
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0095476363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1021986Medicaid
VTY400235828Medicare PIN