Healthcare Provider Details

I. General information

NPI: 1912677006
Provider Name (Legal Business Name): AUDRA LUANNE RHINEHARDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 07/17/2023
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLARA BARTON ST
DANSVILLE NY
14437-9527
US

IV. Provider business mailing address

5404 FREEDOM LN APT 305
JAMESTOWN NC
27282-7824
US

V. Phone/Fax

Practice location:
  • Phone: 585-355-6001
  • Fax:
Mailing address:
  • Phone: 252-723-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11634
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number27665
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: