Healthcare Provider Details

I. General information

NPI: 1730506692
Provider Name (Legal Business Name): RASA AUSTREVICIUTE RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S DETROIT AVE
TOLEDO OH
43614-2701
US

IV. Provider business mailing address

5933 WALNUT CIR APT U
TOLEDO OH
43615-6645
US

V. Phone/Fax

Practice location:
  • Phone: 419-381-1881
  • Fax:
Mailing address:
  • Phone: 419-265-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number335496
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: