Provider Demographics
NPI:1760032148
Name:TRAUTMAN, NOVA BOGNOT
Entity Type:Individual
Prefix:MRS
First Name:NOVA
Middle Name:BOGNOT
Last Name:TRAUTMAN
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 1:2318 CAMBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-5333
Mailing Address - Country:US
Mailing Address - Phone:605-342-1335
Mailing Address - Fax:605-342-1335
Practice Address - Street 1:2318 CAMBRIDGE PL
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-5333
Practice Address - Country:US
Practice Address - Phone:605-342-1335
Practice Address - Fax:605-342-1335
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide