Healthcare Provider Details

I. General information

NPI: 1386105021
Provider Name (Legal Business Name): JASON LEE RAUSCH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SUMMIT ST
YANKTON SD
57078-3855
US

IV. Provider business mailing address

1201 E 57TH ST APT 10
SIOUX FALLS SD
57108-5417
US

V. Phone/Fax

Practice location:
  • Phone: 605-351-3583
  • Fax:
Mailing address:
  • Phone: 605-351-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR001012
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: