Healthcare Provider Details

I. General information

NPI: 1578028981
Provider Name (Legal Business Name): JADA RAUSCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LN
PIERRE SD
57501-3391
US

IV. Provider business mailing address

801 E SIOUX AVE
PIERRE SD
57501-3323
US

V. Phone/Fax

Practice location:
  • Phone: 605-945-5210
  • Fax:
Mailing address:
  • Phone: 605-945-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01191726
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: