Healthcare Provider Details

I. General information

NPI: 1811536089
Provider Name (Legal Business Name): SARA RAUSCH CBP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2020
Last Update Date: 01/05/2020
Certification Date: 01/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13027 LEBARON LN
ALBERTON MT
59820-9496
US

IV. Provider business mailing address

13027 LEBARON LN
ALBERTON MT
59820-9496
US

V. Phone/Fax

Practice location:
  • Phone: 406-239-4136
  • Fax:
Mailing address:
  • Phone: 406-239-4136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-30273
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberBODYTALK
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: