Healthcare Provider Details

I. General information

NPI: 1467826255
Provider Name (Legal Business Name): SADIE S RAUSCHENBACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E SAINT PETER ST
NEW IBERIA LA
70560-3932
US

IV. Provider business mailing address

1110 E ST PETER ST.
NEW IBERIA LA
70560
US

V. Phone/Fax

Practice location:
  • Phone: 337-364-1166
  • Fax: 337-364-7090
Mailing address:
  • Phone: 337-364-1166
  • Fax: 337-364-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number300549
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: