Provider Demographics
NPI:1932340593
Name:RAUCH, MARY HEATHER (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HEATHER
Last Name:RAUCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HEATHER
Other - Last Name:SNODGRASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4993 151ST ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:IA
Mailing Address - Zip Code:52207-9666
Mailing Address - Country:US
Mailing Address - Phone:563-652-6798
Mailing Address - Fax:
Practice Address - Street 1:4993 151ST ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:IA
Practice Address - Zip Code:52207-9666
Practice Address - Country:US
Practice Address - Phone:563-652-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094493163WC0200X
IL041-301579163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine