Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN.CNP.16719 | OH |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | COA.16719-NP | OH |
NPI | 1316345440 |
---|---|
Provider Name | Mr. Bryan W. Rauch |
First Address | Perrysburg, OH 43551-2983 |
Second Address | Perrysburg, OH 43551-2983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2014 |
Last Update Date | 12/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0115148 | (05) | OH |