Provider Demographics
NPI:1760034961
Name:RAUDABAUGH, ROBERTA ELAINE
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ELAINE
Last Name:RAUDABAUGH
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 1:551 BARNSTABLE RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9413
Mailing Address - Country:US
Mailing Address - Phone:717-422-4177
Mailing Address - Fax:
Practice Address - Street 1:551 BARNSTABLE RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9413
Practice Address - Country:US
Practice Address - Phone:717-422-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA43393601OtherHOME CARE SERVICES