Healthcare Provider Details

I. General information

NPI: 1659001063
Provider Name (Legal Business Name): RACHEL ANNE KRAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 SIGNATURE DR N
XENIA OH
45385-9100
US

IV. Provider business mailing address

8699 DIJON CT
CENTERVILLE OH
45458-2886
US

V. Phone/Fax

Practice location:
  • Phone: 850-650-7445
  • Fax:
Mailing address:
  • Phone: 937-474-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: