Healthcare Provider Details

I. General information

NPI: 1528712353
Provider Name (Legal Business Name): KRISTIN RAUBACH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 847-997-2385
  • Fax:
Mailing address:
  • Phone: 720-777-6600
  • Fax: 720-777-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1627062
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0997348-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: