Provider Demographics
NPI:1891880811
Name:RAUSCHER, BEVERLY DIANE (PA-C)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DIANE
Last Name:RAUSCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17290 JASMINE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7709
Mailing Address - Country:US
Mailing Address - Phone:760-951-2400
Mailing Address - Fax:760-951-3301
Practice Address - Street 1:17290 JASMINE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7709
Practice Address - Country:US
Practice Address - Phone:760-951-2400
Practice Address - Fax:760-951-3301
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01489363AM0700X
CAPA20609363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS31585Medicare UPIN
TX83N886Medicare ID - Type Unspecified