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General NPI Number Information
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NPI Number | 1235291774
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Entity Type | Individual
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Provider Name | TERRY SUE HAYRYNEN-RAUCH DO
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 1414 W, FAIR AVE, SUITE 285 VA MARQUETTE CBOC
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-226-4618
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Fax | 906-226-5317
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Provider Business Mailing Address
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Address Line | 1414 FAIR AVE, SUITE 285 VA CBOC
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-226-4618
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Fax | 906-265-4245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5101008892
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101008892
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License Number State | MI
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