Healthcare Provider Details

I. General information

NPI: 1316345440
Provider Name (Legal Business Name): BRYAN W. RAUCH NP-C, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 11/03/2023
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25950 DIXIE HWY STE 400
PERRYSBURG OH
43551-2983
US

IV. Provider business mailing address

25950 DIXIE HWY STE 400
PERRYSBURG OH
43551-2983
US

V. Phone/Fax

Practice location:
  • Phone: 567-585-0010
  • Fax: 567-225-3490
Mailing address:
  • Phone: 567-585-0010
  • Fax: 567-225-3490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.16719
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberCOA.16719-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: